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Review
. 2023 May;33(3):1294-1307.
doi: 10.1177/11206721221141481. Epub 2022 Dec 5.

Management of inflammation in dry eye disease: Recommendations from a European panel of experts

Elisabeth M Messmer  1 , Sajjad Ahmad  2 , José M Benitez Del Castillo  3 , Ewa Mrukwa-Kominek  4 , Maurizio Rolando  5 , Oksana Vitovska  6 , Christophe Baudouin  7 ; a panel of European dry eye disease experts
Affiliations
Review

Management of inflammation in dry eye disease: Recommendations from a European panel of experts

Elisabeth M Messmer et al. Eur J Ophthalmol. 2023 May.

Abstract

Introduction: Early initiation of anti-inflammatory therapies is recommended for dry eye disease (DED) to break the vicious cycle of pathophysiology. However, there is limited guidance on how to implement topical ciclosporin (CsA) and corticosteroid treatment into clinical practice. This expert-led consensus provides practical guidance on the management of DED, including when and how to use topical CsA.

Methods: A steering committee (SC) of seven European DED experts developed a questionnaire to gain information on the unmet needs and management of DED in clinical practice. Consensus statements on four key areas (disease severity and progression; patient management; efficacy, safety and tolerability of CsA; and patient education) were generated based on the responses. The SC and an expanded expert panel of 22 members used a nine-point scale (1 = strongly disagree; 9 = strongly agree) to rate statements; a consensus was reached if ≥75% of experts scored a statement ≥7.

Results: A stepwise approach to DED management is required in patients presenting with moderate corneal staining. Early topical CsA initiation, alone or with corticosteroids, should be considered in patients with clinical risk factors for severe DED. Patient education is required before and during treatment to manage expectations regarding efficacy and tolerability in order to optimise adherence. Follow-up visits are required, ideally at Month 1 and every 3 months thereafter. Topical CsA may be continued indefinitely, especially when surgery is required.

Conclusion: This consensus fills some of the knowledge gaps in previous recommendations regarding the use of topical corticosteroids and CsA in patients with DED.

Keywords: Dry eye disease; ciclosporin; consensus; corticosteroids; disease management; inflammation; patient education.

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Conflict of interest statement

EM received grant support from Chiesi Farmaceutici; consulting fees from Alcon/Novartis, DMG Pharma, Dompé Farmaceutici, Kala Pharmaceuticals, Allergan/AbbVie, Santen, Shire/Takeda, Sun Pharmaceutical Industries Ltd, Sifi, Théa Pharmaceuticals, TRB Chemedica AG and VISUfarma; honoraria for participation in educational events from Alcon/Novartis, Dompé Farmaceutici, Novartis, Allergan/AbbVie, Santen, Théa Pharmaceuticals, TRB Chemedica AG, URSAPHARM and VISUfarma; consulting fees from DMG Pharma, Kala Pharmaceuticals, Novartis, Santen, Shire/Takeda, Sifi, TRB Chemedica AG and VISUfarma; is a member of the executive committee of the German Ophthalmological Society and the treasurer for the European Dry Eye Society. SA received honoraria for participation in educational events from Santen. JMBC received consulting fees from GSK and Brill Pharma SA; honoraria for participation in educational events from Santen, Théa Pharmaceuticals, Allergan/AbbVie, Alcon/Novartis, Angelini Pharma and Horus Pharma. EMK received grant support from Alcon/Novartis; honoraria for participation in educational events from Alcon/Novartis, Théa Pharmaceuticals, URSAPHARM, Verco, PolPharma, Bausch Health, Adamed and ABJ Vision; support for attending meetings and/or travel by Alcon/Novartis and Théa Pharmaceuticals; consulting fees from Alcon/Novartis, Théa Pharmaceuticals, Santen, Alfasigma and Valeant Pharmaceuticals/Bausch Health; is a board member of the Polish Ophthalmological Society and a committee member of the European Society of Cataract & Refractive Surgeons. MR received grant support from Sifi, Théa Pharmaceuticals and Alfa Intes; royalties/licences from Relmada Therapeutics and Baif International; honoraria for educational events from Santen, Théa Pharmaceuticals and Allergan/AbbVie; consulting fees from Sifi, Théa Pharmaceuticals and Relmada Therapeutics; support for attending meetings and/or travel from Allergan/AbbVie, Alcon/Novartis, Théa Pharmaceuticals and Sifi; received equipment, materials, drugs, gifts or other services from Santen and Théa Pharmaceuticals. OV is a member of the Ukrainian Alliance of Ophthalmologists (unpaid), declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. CB received grant support from Santen, Théa Pharmaceuticals and Horus Pharma; consulting fees from Santen, Théa Pharmaceuticals, Alcon/Novartis, Allergan/AbbVie and Horus Pharma.

Figures

Figure 1.
Figure 1.
Vicious circle of DED pathophysiology. LASIK: laser-assisted in situ keratomileusis; MGD: meibomian gland dysfunction; MMP: matrix metalloproteinase. Image adapted from Baudouin C, et al. 2013.
Figure 2.
Figure 2.
Representation of the bridging approach with topical CsA and corticosteroids. CsA: ciclosporin A. Treatment with topical CsA could either be started simultaneously with corticosteroids or initiated at a later stage (e.g., 1 week later). Image adapted from Pleyer U, et al. 2020.
See this image and copyright information in PMC

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