Restasis (Cyclosporine) as an Ocular Rosacea Treatment

Written by on July 2, 2009 in Ocular Rosacea, research with 9 Comments
restasis-cyclosporin

It is good to see more published research backing topical cyclosporine (Restasis, Allergan) as a treatment for ocular rosacea. Restasis (cyclosporine ophthalmic emulsion 0.05%) has been shown to increase tear production and improve the quality of naturally produced tears and is the first approved therapeutic agent for the treatment of chronic dry eye.

Official Use of Restasis

The FDA has approved Restasis as a treatment to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with chronic dry eye. Note that increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs. Restasis is not appropriate for immediate relief for an uncomfortable irritated eye as it may take up to 6 months for maximum improvement. (source The Eye Digest)

Other Evidence

An article from 2006 in Ophthalmology Management Topical cyclosporine proves to be effective in treating rosacea whetted our appetite for this interesting new treatment.

The anti-inflammatory mechanisms of cyclosporine are highly appropriate for the treatment of ocular rosacea, as the condition has been shown to have an inflammatory etiology. Barton and associates conducted a study comparing tear fluid concentrations of interleukin-1alpha (IL-1alpha) and tumor necrosis factor-alpha (TNF-alpha) in ocular rosacea with those in control subjects. Tear turnover was lower in patients with rosacea than in controls, and Schirmer scores were also statistically lower in patients with rosacea than in controls.

After 6 months of use, topical cyclosporine was shown to decrease inflammatory cytokines in the conjunctival epithelium of dry eye patients with increased tear production.

Given the excellent side effect profile of topical cyclosporine and its lack of systemic absorption, ophthalmologists should consider utilizing topical cyclosporine in the treatment of patients with ocular rosacea.

Expert Opinion

The Rosacea Support Group asked Dr. Eric Jones, MD, the Medical Director of Devers Eye Institute in Portland, Oregon a related question about Restasis and ocular rosacea.

Q: Do you agree with the view that Restasis won’t help ocular rosacea or dry eye triggered by Accutane?

A: The drug rep was in for Restasis the other day and I asked her about it. We looked it up here and didn’t find any studies that checked on Restasis and ocular rosacea together. It’s a great question because, you know people with ocular rosacea have decreased tear production and, if Restasis can help that, I don’t see why it wouldn’t work.

Recent Abstract

Below is the abstract from the recently published paper, from the same author as the above article, but now appearing in a peer reviewed journal. The above link to Ophthalmology Management leads to a full article, which can be consulted for more details if you don’t have access to the full text of the journal article.

Efficacy of topical cyclosporine for the treatment of ocular rosacea, Adv Ther. 2009 Jun 23, Schechter BA, Katz RS, Friedman LS, Florida Eye Microsurgical Institute.

INTRODUCTION: This study was designed to compare the efficacy of cyclosporine ophthalmic emulsion 0.05% with an artificial tear solution for the treatment of rosacea-associated eyelid and corneal pathology.

METHODS: Double-masked, randomized, 3-month clinical trial of 37 patients with rosacea-associated eyelid and corneal changes (defined as lid margin telangiectasia, meibomian gland inspissation, and/or fullness of the lid margin). All findings were standardized and compared to photographs for grading.

RESULTS: There was a statistically significant increase in Schirmer (with anesthesia) scores of 2.7+/-2.2 mm after 3 months of treatment in the topical cyclosporine group (P<0.001), compared with a mean decrease of -1.4+/-4.6 mm (P=0.271) in the artificial tears group. The mean tear break-up time score significantly improved in the topical cyclosporine group (mean increase of 3.56+/-1.5 seconds, P<0.001), but worsened in the control group, although this change was not significantly significant (mean decrease of -0.04+/-1.6 seconds, P=0.929). The topical cyclosporine group exhibited a significantly greater mean reduction in corneal staining scores (-1.3+/-0.53) compared with the control group (-0.2+/-0.83; between groups P<0.001). The topical cyclosporine group had a greater improvement in Ocular Surface Disease Index scores than those using artificial tears (P=0.022). Limitations of the study included an older, predominantly Caucasian patient population and short trial length.

CONCLUSIONS: Topical cyclosporine 0.05% is more effective than artificial tears for the treatment of rosacea-associated lid and corneal changes.

Related Articles

Read more about: Ocular Rosacea, research

About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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9 Reader Comments

  1. David Pascoe says:

    comment via email from Bill:

    Restasis is the product of a marketing machine. And nothing else.

    I’ve never received so much marketing from manufacturer and insurer and druggist as use of this product generated. Nothing close.

    And now this.

    But thanks in general for the info you provide.

    Bill

  2. Very interesting review, we need more reviews like this to empower the consumers. Good community comments as well!

  3. mary m says:

    Normally I don’t take the time to write reviews of anything, but the Made from Earth Green Tea Toxin Cleanser has changed my mind.

    I am a 52-year-old woman and have had rosacea my entire adult life. It started out as acne when I was a teenager, then progressed to the rosacea stage later on, with much less acne. I have tried oral antibiotics, gels, lotions, and all of these were dermatologist prescribed. I even tried Murad products. Some treatments improved my complexion a little, some made my rosacea flare up even worse.

    When I read some reviews about the Made from Earth products on the internet, I decided to try the Made from Earth “Green Tea Toxin Cleanser”. Well…what a surprise.

    After just a few weeks (while also using themade from earth rosehip serum) the redness was diminished, and after almost a month now, my rosacea symptoms are all but history. I just can’t believe it.

    I don’t know what’s in that stuff, but it works for me. I am completely satisfied with it. There is no odor, no greasiness as with some ointments. In fact, after applying it seems to tighten and smooth everything a little, and I have found that I receive all the benefits even using it once daily, in the morning.

    I suppose if I used it twice daily I would probably have even better results. I guess I just wanted to make the tube last longer.

    I wish they would make it in a larger size, then I may be more apt to use it more often, even though I don’t really need to. My verdict is: if you have any symptoms of rosacea, give this a try and see if it doesn’t improve your complexion quickly.

  4. Mindy says:

    I’ve been using Restasis for intractable ocular rosacea for over a year.

    I had 3 surgeries for tear duct issues brought about by eye inflammation from the rosacea. I had multiple rounds of steroid drops, tried allergy drops, saline drops, minocycline, hot soaks – you name it.

    I tried Restasis as a last resort. It has been a miracle for me! My eyes are functional and comfortable. Tear ducts are open. I only wish I had tried it at the very start and avoided years of misery.

  5. David Pascoe says:

    Thanks for your comment Mindy. Great to hear that this is working well for you.

  6. may says:

    my daughter is 10 years old they prescribed for her restasis to use for six month but as a mum i am i dont know what to do i read a lot a bout that eye drops and i used it for 9 weeks in lebanon.It worked but they told me its not avalable in Australia what can i do.

  7. Dianne says:

    When I read Mindy’s comments I felt I was reading about myself…I too tried everything she mentioned with a few other eye drops and saw 4 different opthamologists before I finally mentioned Restasis to my latest doc. It too has been like a miracle for me!!! My eyes are also functional and comfortable after years of misery! I guess I had to go through everything I did to get where I am today and am just so thankful! Felt inclined to write and share.

  8. Irene McDonald says:

    There is a new type of eye drop available for dry eyes available at optometrists. It is made from Hyaluronic Acid a magic ingredient also used in skin care. Cod liver oil capsules fortified with Vitamin A will also help dramatically but take longer.

    I spent years looking like I’d been crying all the time with red eyes. One cause was eye drops for allergies which was what I thought was the cause of the dry irritated eyes. Cod liver oil fixed me.

    For styes or lumps that come up and hang around the eye lids, a simple treatment is a tiny amount of Manuka honey applied on a cotton bud twice a day. Gently clean the lid with water first. Manuka honey is available at health food shops and pharmacies as Medi honey.

    I love the idea of non prescription or antibiotic if possible. Drug companies love we rosacea sufferers.

  9. Melanie says:

    On my 3rd week of using restastis and on my 3rd stye. The innermost top corner of my one eye is swollen with a stye/head on the insideof the lid. The swelling is pronounced. After the last time the dr said it was not from the restasis and to continue. Now im on number 3.

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