Purchase this article with an account.
E. Bouzas, P. Karadimas, I. Kotsiras, G. Mastorakos; Topical Cyclosporin 0.05% Ophthalmic Emulsion in Patients With Dysthyroid Ophthalmopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2659.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: Ophthalmopathy is a main feature of Graves’ disease. Proptosis, diplopia and decrease of vision represent the main concerns from this disease in its severe form. However, even patients with mild involvement, may experience marked discomfort. Discomfort is the result of corneal exposure (due to proptosis, lid retraction, impaired Bell's phenomenon and abnormal blinking), reduced tear secretion and inflammation of the conjunctiva. In such cases current management is limited to artificial tears. Topical cyclosporine A eyedrops have recently been used in the treatment of moderate to severe dry eye disease but also, in other conditions as atopic keratoconjunctivitis and superior limbal keratoconjunctivitis. In addition, systemic cyclosporine A had been used in the treatment of dysthyoid ophthalmopathy. We used topical cyclosporine A in a pilot study for the treatment of patients with Graves’ ophthalmopathy. Methods: Forty patients with Graves’ ophthalmopathy of mild or moderate severity, either without specific treatment or at least 6 months after the end of any treatment for severe ophthalmopathy, participated in the study. Inclusion criteria were: marked discomfort, ocular surface damage, oedema of the conjunctiva, Schirmer test < 10 mm and a clinical picture stable for two months before enrollment. Patients were randomly assigned in two groups: one received topical Cyclosporine A ophthalmic emulsion 0.05% (x2) and the other, placebo. Patients were examined at enrollment and at 15 days, 1 and 3 months. Patients underwent complete ocular examination. Conjunctival oedema and hyperemia, punctate keratitis and Rose Bengal staining were graded. Schirmer test and BUT were recorded. Patient completed a detailed questionnaire about their symptoms (discomfort, foreign body sensation, tearing, photophobia, use of tear drops). Results: Eigteen of 20 (90 %) treated patients showed improvement of the signs. BUT increased from 4 sec to 12 sec and Schirmer test from 7 to 16 mm. All patients in the treatment group (100%) reported improvement based on the questionnaire. Only one patient showed improvement in the control group based on signs and 3 based on symptoms (P<0.05). No side effects were recorded. Conclusions: Topical cyclosporin A 0.05% seems to be a safe treatment, effective in alleviating discomfort and decreasing signs of exposure keratopathy and conjunctival inflammation in patients with dysthyroid ophthalmopathy.
This PDF is available to Subscribers Only