Loteprednol Etabonate for the Treatment of Dry Eye Disease

Abstract

Dry eye disease (DED) is a common ocular condition that can impair vision and may adversely impact quality of life. Due to the inflammatory nature of this disorder, topical corticosteroids are an effective treatment option, particularly for moderate-to-severe DED when first-line treatments, such as ocular lubricants, are insufficient. Loteprednol etabonate (LE) is a retrometabolically designed corticosteroid with a low propensity to cause corticosteroid-related adverse effects, such as elevated intraocular pressure (IOP). This review was conducted to provide an assessment of published studies on the use of LE for treatment of inflammation associated with DED. Twelve prospective and 2 retrospective studies evaluating LE ophthalmic suspension 0.5% and 2 prospective studies evaluating LE ophthalmic gel 0.5% were identified. LE given as monotherapy or with artificial tears (AT) improved signs of DED, especially among patients with a more pronounced inflammatory component, and also improved DED symptoms compared to baseline and/or control. Treatment with LE before cyclosporine A (CsA) therapy reduced stinging upon CsA initiation and provided more rapid relief of DED signs and symptoms than CsA plus AT alone. In patients with meibomian gland dysfunction, LE alone, or in addition to eyelid scrubs/warm compresses, reduced clinical signs and symptoms, and tear proinflammatory cytokine levels. Overall, LE was safe and well tolerated, with minimal effects on IOP. While larger and longer-term studies are warranted, these data support the use of LE as a safe and effective treatment option for DED.

Keywords: dry eye disease; inflammation; intraocular pressure; loteprednol etabonate; ocular surface.

FIG. 1.

Changes of Schirmer test (A), TBUT (B), keratoepitheliopathy (C), and symptom score (D) in the LE 0.5% and fluorometholone 0.1% groups. Group A, LE group; Group B, fluorometholone group, *P < 0.05 versus the baseline. From Jung et al. Reproduced without modification under the Creative Commons Attribution Noncommercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium. LE, loteprednol etabonate; TBUT, tear film breakup time.

FIG. 2.

Mean ± SEM OSDI scores for LE+tCsA− (n = 57) and AT+tCsA− (n = 55)-treated patients at baseline and at each of the study visits. OSDI scores for LE+tCSA− and AT+tCsA-treated patients at baseline and at each day of the study. *Statistically significant versus baseline, P < 0.05. From Sheppard et al. Reproduced with permission from Wolters Kluwer Health. The Creative Commons license does not apply to this content. Use of the material in any format is prohibited without written permission from the publisher, Wolters Kluwer Health, Inc., Please contact permissions@lww.com for further information. AT, artificial tears; OSDI, Ocular Surface Disease Index; SEM, standard error of the mean; tCsA, topical cyclosporine A.