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C.W. Roberts, P.E. Carniglia, B.G. Brazzo; Comparison of Cyclosprine to Punctal Plugs in Relieving the Signs and Symptoms of Dry Eyes . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2027.
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Purpose: To compare the efficacy of cyclosporine ophthalmic emulsion 0.05% to punctual plugs in relieving the signs and symptoms of dry eyes. Methods:30 patients with chronic symptoms of dry eye in both eyes (scratchy or burning eyes relieved at least in part by artificial tears) and conjunctival staining with rose bengal were randomized to one of three treatment groups. 1. Cyclosporine ophthalmic emulsion 0.05% twice a day; 2. Punctal plugs to lower lids only; 3. Both cyclosporine and punctual plugs (Combination). Patients were evaluated at initial visit and then one, three, and six months after initiation of treatment by Schirmer measurement without anesthesia (three minutes),rose bengal staining of the cornea and conjunctiva, and patient reporting of the number of times per day they apply artificial tears. Results: Increased Schirmer measurements: Combination = Plugs > Cyclosprine. Improvement in conjunctival staining: Combination = Cyclosporine > Plugs. Decreased frequency of artifical tears: Combination > Cyclosporine > Plugs. Conclusions: While punctual plugs increase Schirmer measurement of tear production, cyclosporine is more effective in decreasing the conjunctival staining and need for artificial tears seen in dry eyes. There is a synergy of these two modes of improving dry eyes such that the use in combination was the most effective in relieving both the signs and symptoms of dry eyes.
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