Advances in Therapy

, Volume 26, Issue 6, pp 651–659 | Cite as

Efficacy of topical cyclosporine for the treatment of ocular rosacea

  • Barry A. SchechterEmail author
  • Randy S. Katz
  • Lee S. Friedman
Original Research



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.


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.


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.


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


artificial tears cyclosporine meibomian gland ocular rosacea telangiectasia 


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  1. 1.
    Ghanem VC, Mehra N, Wong S, Mannis MJ. The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics. Cornea. 2003;22:230–233.CrossRefPubMedGoogle Scholar
  2. 2.
    Marmion VJ. Tetracyclines in the treatment of ocular rosacea. Proc R Soc Med. 1969;62:11–12.PubMedGoogle Scholar
  3. 3.
    Akpek EK, Merchant A, Pinar V, Foster CS. Ocular rosacea: patient characteristics and follow-up. Ophthalmology. 1997;104:1863–1867.PubMedGoogle Scholar
  4. 4.
    Bowman RW, McCulley JP, Jester JV. Meibomian gland dysfunction and rosacea. In: Pepose J, Holland G, Wilhelmus K, eds. Ocular Infection and Immunity. St. Louis: Mosby-Year Book; 1996:334–343.Google Scholar
  5. 5.
    Kocak-Altintas AG, Kocak-Midillioglu I, Gul U, et al. Impression cytology and ocular characteristics in ocular rosacea. Eur J Ophthalmol. 2003;13:351–359.PubMedGoogle Scholar
  6. 6.
    Barton K, Monroy DC, Nava A, Pflugfelder SC. Inflammatory cytokines in the tears of patients with ocular rosacea. Ophthalmology. 1997;104:1868–1874.PubMedGoogle Scholar
  7. 7.
    Bron AJ. Diagnosis of meibomian gland disease and MKC: what is really meant by meibomian inflammation? Am J Ophthalmol. 2005;139:S23–S24.CrossRefGoogle Scholar
  8. 8.
    Macsai M. The role of Omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis). Trans Am Ophthalmol Soc. 2008;106:336–356.PubMedGoogle Scholar
  9. 9.
    Jansen T, Plewig G. Rosacea: classification and treatment. J R Soc Med. 1997;90:144–150.PubMedGoogle Scholar
  10. 10.
    Wilken J, Dahl M, Detmar M, et al. Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. J Am Acad Dermatol. 2002;46:584–587.CrossRefGoogle Scholar
  11. 11.
    Randleman JB, Loft E, Song CD. Ocular rosacea. Available at: Accessed Nov. 7, 2006.
  12. 12.
    Donnenfeld E, Pflugfelder SC. Topical ophthalmic cyclosporine: Pharmacology and clinical uses. Surv Ophthalmol. 2009;54:321–338.CrossRefPubMedGoogle Scholar
  13. 13.
    Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. Ophthalmology. 2000;107:631–963. Erratum in: Ophthalmology. 2000;107:1220.CrossRefPubMedGoogle Scholar
  14. 14.
    Restasis [package insert]. CA: Allergan Inc.; 2004.Google Scholar
  15. 15.
    Kunert KS, Tisdale AS, Stern ME, et al. Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol. 2000;118:1489–1496.PubMedGoogle Scholar
  16. 16.
    Doan S, Gabison E, Gatinel D, Duong M-H, Abitbol O, Hoang-Xuan T. Topical cyclosporine A in severe steroid-dependent childhood phlyctenular kerato-conjunctivitis. Am J Ophthalmol. 2006;141:62–66.CrossRefPubMedGoogle Scholar
  17. 17.
    Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000;118:615–621.PubMedGoogle Scholar
  18. 18.
    Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003;22:640–650.CrossRefPubMedGoogle Scholar
  19. 19.
    Driver PJ, Lemp MA. Meibomian gland dysfunction. Surv Ophthalmol. 1996;40:343–367.CrossRefPubMedGoogle Scholar
  20. 20.
    Zengin N, Tol H, Gunduz K, et al. Meibomian gland dysfunction and tear film abnormalities in rosacea. Cornea. 1995;14:144–146.CrossRefPubMedGoogle Scholar
  21. 21.
    Turner K, Pflugfelder SC, Ji Z, et al. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. Cornea. 2000;19:492–496.CrossRefPubMedGoogle Scholar
  22. 22.
    Perry HD, Wittpenn JR, D’Aversa G, Donnenfeld ED. Topical cyclosporine 0.05% for the treatment of chronic, active ocular rosacea. Poster presented at: Annual Meeting of the Association for Research in Vision and Ophthalmology; May 3, 2005; Ft. Lauderdale, Florida, USA.Google Scholar
  23. 23.
    Perry HD, Doshi-Carnevale S, Donnenfeld ED, et al. Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction. Cornea. 2006;25:171–175.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Healthcare Communications 2009

Authors and Affiliations

  • Barry A. Schechter
    • 1
    Email author
  • Randy S. Katz
    • 1
  • Lee S. Friedman
    • 1
  1. 1.Florida Eye Microsurgical InstituteFloridaUSA

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