Cyclosporine Eye Drops: Uses, Side Effects, Dosage, And More
Cyclosporine Eye Drops
Eye drops are generally prescribed to relieve dryness and irritation in the sclera and cornea. In an injured eye, eye drops also promote surface healing. Cyclosporine eye drops, in particular, flush out any residual contaminating or injurious particles. Moreover, they prevent further damage by keeping the eye lubricated and moist for a long duration.
Cyclosporine eye drops belong to a class called immunomodulators. Immunomodulation is usually defined as changing the physiological immune response. This can be either activated or suppressed using natural or pharmaceutical agents. It involves targeting specific inflammatory mediators to better control the disease and minimize the damage associated with it.
These immunomodulating agents decrease swelling in the eye along with preventing redness and itchiness. Redness and itchiness in the eye may be a direct result of an infection by a pathogen or a mild allergic reaction. Thus, it is clear that cyclosporine eye drops offer a plethora of benefits. We shall now delve into their appropriate usage.
Cyclosporine is being used from time immemorial to treat a variety of conditions that have an underlying inflammatory basis, including psoriasis, ulcerative colitis, and ocular inflammation. The use of cyclosporine to treat ocular conditions has been met with somewhat mixed results in the treatment of nonspecific, non-infectious inflammatory diseases. However, recently developed compounds may provide better treatment without the adverse reactions associated with the historical use of cyclosporine.
Restasis was the first cyclosporine eye drop approved by the US Food and Drug Administration (FDA) in 2003 for keratoconjunctivitis sicca (KCS) treatment. Restasis was approved based on a statistically significant improvement in tear production in those suffering from chronic KCS or dry eye syndrome.
Tear production gets affected when lymphocytes die and accumulate in the tear glands. Cyclosporine eye drops are also used to reverse this condition, increasing tear production by a great deal. However, immediate results are not seen. An increase in tear production is generally not noticed until 3 to 6 months of starting treatment.
Ocular tissues have a low tolerance for inflammation, so even mild inflammation may cause severe vision impairment. Therefore, it is crucial to prevent the harmful effect of inflammatory responses or chronic immune activation and revert it. Acting early by blocking the resting lymphocytes in the initial stages of the cell cycle, cyclosporine leads to their programmed cell death (apoptosis).
2. Side Effects
Keratoconjunctivitis sicca is a chronic disorder requiring long-term local therapy for the majority of afflicted patients. Cyclosporine typically must be continued for an extended period, and in most patients, indefinite treatment is necessary to prevent relapse. However, clinical research has found that a small subgroup of patients starts seeing symptoms of side effects after the initial months.
These side effects include:
- A temporary stinging sensation in the eye
- Blurred vision
- Redness and itching in the eyes
- Watery eyes and discharge
To prevent microbial contamination, cyclosporine eye drops contain chemical preservatives, which induce toxic and allergic reactions, especially in individuals with sensitive eyes. Quite serious complications were noted in less than 0.1% of the survey patient group. These included renal and neural toxicity from systemic use of cyclosporine.
Cyclosporine has also been shown to promote the formation of a neoplasm and may lead to hypertension, hyperlipidemia, and nephrotoxicity. Persistent use may also increase the risk of viral and fungal infections in the body as cyclosporine phagocytoses lymphocytes, a type of white blood cell.
It becomes essential to note that these potentially hazardous side effects only come into play on systemic use of these eye drops over 2-3 years. In contrast to the systemic use of cyclosporine, topical application has nearly negligible side effects. This is primarily because only small amounts of cyclosporine can penetrate the bloodstream after topical application.
These eye drops are safe to use with lubricant eye drops like artificial tears. After putting in your artificial tears, you must wait 15 minutes before putting the cyclosporine eye drops into your eyes. Refrain from putting these eye drops in your eye while wearing contact lenses. The cyclosporine can completely degrade the silicone in the lens and cause permanent optic damage to the user.
If contact lenses are worn, they should be removed before the administration of the emulsion. Lenses may be reinserted 15 minutes following administration of the cyclosporine ophthalmic emulsion. Moreover, remember to not shake the vial before application of the eye drops.
The emulsion from one individual single-use vial is to be used immediately after opening for administration to one or both eyes. The remaining contents, if any at all, should be discarded immediately after administration. Ensure that you do not touch the tip of the eye dropper or place it directly upon your eye. A contaminated dropper can cause infections leading to serious vision problems.
Environmental conditions that increase tear evaporation and factors that may decrease tear production ought to be minimized or eliminated. Artificial tears or ocular lubricants that are preservative-free are often successful in mitigating symptoms in mild cases. The dosage of cyclosporine eye drops is:
- For adults and children 16 years of age and older: 1 drop in each eye every 12 hours.
- For children younger than 16 years of age: Use and dose is to be determined by a doctor.
Thus, cyclosporine eye drops are usually instilled in each eye twice a day, about 12 hours apart. Repeat this procedure around the same time every day for at least 6 months. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist for any further explanation.
Use cyclosporine eyedrops exactly as directed and don’t change the dosage prescribed by your doctor. Make sure that the emulsion is opaque and has a white colored consistency.
5. Detrimental Effects Of Overdosing
Even if you miss the previous day’s dose, do not double the dose in a single day. Symptoms of an overdose can include increased eye irritation along with redness in the eyes. Swollen eyelids and persistent blurred vision can be other telling symptoms of an overdose.
However, the specific effects will vary, based on how much has been consumed and whether cyclosporine was used as an eye drop or taken by mouth. Treatment will likely involve supportive care, which consists of treating any symptoms that result from the overdose. If the symptoms are severe, call 911 or go to the nearest emergency room right away.
6. Interaction With Other Medications
Since cyclosporine here is given via the ophthalmic route, there are no real drug interactions that come into play on its usage. Cyclosporine in eye drops is not potent enough to pass into the bloodstream. This ensures almost no negative drug interaction that would potentially affect the overall health of the user.
However, it’s still important to talk to your doctor or pharmacist about any vitamins, supplements, and over-the-counter medications you take before starting the use of cyclosporine eye drops. If you are unable to visit the physician for some reason, you can always avail the use of telephonic or e-consultations. The pharmacy you are looking to buy the cyclosporine eye drops from may also have an in-house doctor.
Always consult a physician before starting any new medication to eliminate all probable risks. Pregnant and lactating mothers should generally avoid the use of any steroidal concoction, even if it is administered via the ophthalmic route.
Also Read: Why Do My Eyes Burn?
Cyclosporine is one of the few medications that aims at restoring normal tear osmolarity and decreasing ocular surface damage. A minimum twice-a-day six-month course of cyclosporine eye drops is advised to patients with KCS. Patients must understand that KCS is a life-long condition requiring long-term therapy in most patients. Adjacent short-term treatment with topical corticosteroids may reduce the side effects and speed up the response to cyclosporine treatment.
Cyclosporine 0.05% (formulated as Restasis) is the only FDA-approved prescription drug available for patients with KCS in the United States. It has also been used as a treatment for other conditions that may be secondary to KCS. Since most users respond relatively well to cyclosporine eye drops, it is looked upon as a reliable option that is prescribed frequently by ophthalmologists across the world.
There is still significant research going on to understand the molecular mode of action of cyclosporine to decode its true potential as an immunomodulating agent.
January 13, 2021 Sam Bell