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Effects of Topical Cyclosporine A Plus Artificial Tears Versus Artificial Tears Treatment on Conjunctival Goblet Cell Density in Dysfunctional Tear Syndrome

Demiryay, Elvan M.D; Yaylal, Volkan M.Dı; Cetin, Ebru Nevin M.D; Yldrm, Cem M.Dııı

Eye & Contact Lens: Science & Clinical Practice: September 2011 - Volume 37 - Issue 5 - p 312-315
doi: 10.1097/ICL.0b013e31822563be

Objectives: The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS).

Methods: Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group.

Results: In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (P<0.001 for all). In the control group, corneal fluorescein staining (P<0.001) and conjunctival lissamine green staining (P=0.014) improved, but BUT and Schirmer scores did not change significantly after treatment. At the end of the 4-month follow-up, the study group demonstrated statistically significantly better BUT (P=0.020), Schirmer scores (P=0.002), goblet cell density (P=0.006), corneal fluorescein staining (P=0.003), and conjunctival lissamine green staining (P=0.017) scores than did the control group.

Conclusions: Topical cyclosporine A and artificial tears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.

From the Department of Ophthalmology, Niğde State Hospital, Niğde, Turkey; and Department of Ophthalmology (V.Y., C.Y., E.N.C.), Faculty of Medicine, Pamukkale University, Denizli, Turkey.

The authors have no funding or conflicts of interest to disclose.

Address correspondence and reprint requests to Volkan Yaylalı M.D., Pamukkale Üniversitesi, Göz Hastalıkları AD, Kınıklı Kampüsü, Kınıklı, Denizli, Turkey; e-mail:

Accepted May 19, 2011.

© 2011 Lippincott Williams & Wilkins, Inc.