When tear substitutes are no longer enough: the role of anti-inflammatory therapy with cyclosporine A in dry eye disease

Sobolta N.S.

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When tear substitutes are no longer enough: the role of anti-inflammatory therapy with cyclosporine A in dry eye disease

October 26, 2026

Sobolta N.S.

УДК: УДК 617.7

DOI: DOI:10.32471/umj.1680-3051.281841

Keywords :

keratoconjunctivitis,

ocular surface inflammation

Resume

Dry eye disease (DED) is currently regarded not as a transient discomfort, but as a chronic progressive disorder of the ocular surface, in the pathogenesis of which tear film instability, hyperosmolarity, epithelial damage, and T-cell-mediated inflammation play key roles. The article summarizes current data on the use of cyclosporine A (CsA) in moderate-to-severe DED, when artificial tear therapy is no longer sufficient. Ikervis — CsA 0.1% in a cationic emulsion administered once daily — is considered a long-term anti-inflammatory treatment option with proven efficacy. In particular, in the PERSPECTIVE study involving 472 patients with severe keratitis associated with DED, corneal fluorescein staining (CFS) decreased from 2.56 to 1.77 at 4 weeks, to 1.24 at 24 weeks, and to 1.10 at 12 months (p<0.0001); an improvement in CFS of at least 1 grade was achieved in 77.5% of patients, while symptom improvement or stabilization was reported in more than 83% of cases. Long-term efficacy is further supported by subsequent observations: in post-SANSIKA, after treatment discontinuation due to marked improvement, 61% of patients remained relapse-free for 2 years, while in the French early access program symptom improvement or stabilization was observed in 94% of patients with severe keratitis. These findings support the rationale for early initiation of cyclosporine A and an adequate treatment duration. Therefore, Ikervis should be considered not only as a means of symptom control, but also as a pathogenetically grounded treatment for chronic immune-mediated inflammation of the ocular surface. To achieve the full clinical effect, treatment should last at least about 160 days and, provided it remains effective and well tolerated, may be continued long term.

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