What is “Dry Eye Syndrome”?

Dry eye is a multifactorial disease of the tears and ocular surface.

Results in symptoms of discomfort, visual disturbance, and tear film instability with
potential damage to the ocular surface.

It is accompanied by increased osmolarity of the tear film and inflammation of the

ocular surface.

Keratoconjunctvitis sicca
 Prevalence of Dry Eye Syndrome

It’s estimated that, one out of every four patients admitted to the eye clinic has dry
eye syndrome.

Prevalence of dry eye disease among

women and men aged over 50 years:
Women 7.8%
Men 4.3%
 Dry eye severity grading scheme (DEWS)
Dry Eye Severity
1 2 3 4*
Level
Discomfort, Mild and/or episodic;
Moderate episodic or Severe frequent or Severe and/or disabling
severity & occurs under
chronic, stress or no stress constant without stress and constant
frequency environmental stress
None or episodic mild Annoying and/or activity- Annoying, chronic Constant and/or
Visual symptoms and/or constant,
fatigue limiting episodic limiting activity possibly disabling
Conjunctival
None to mild None to mild +/- +/++
injection
Conjunctival
staining None to mild Variable Moderate to marked Marked
Corneal staining Severe punctate
None to mild Variable Marked central
(severity/location) erosions
Filamentary keratitis,
Filamentary keratitis,
Mild debris, mucus clumping,
Corneal/tear signs None to mild mucus clumping,
meniscus tear debris,
tear debris
ulceration
Trichiasis,
Lid/meibomian MGD variably present MGD variably present Frequent keratinization,
glands
symblepharon
TFBUT (sec) Variable <10 <5 Immediate
Schirmer score Variable <10 <5 <2
(mm/5 min)

*Must have signs AND symptoms.

TBUT: fluorescein tear break-up time.
MGD: meibomian gland disease
Dry eye treatment (DEWS)

If Level 1 treatments If Level 2 treatments If Level 3 treatments

are inadequate, add: are inadequate, add: are inadequate, add:
 Clinical trials

Over recent years, the efficacy and safety of topical

cyclosporine (CsA) treatment in dry eye have been
demonstrated by numerous clinical trials.
 Decreasing of total lymphocyte counts
Sjögren Syndrome Non-Sjögren
Syndrome
treatment
Before

3965 cell/mm2±1837.3 (n=4) 2291 cell/mm2

(6 months)
After
treatment

819 cell/mm2±396.1 (n=4) 762 cell/mm2

Study shows that, using 0.05% topical cyclosporine in the treatment

of dry eye decreases total lymphocyte counts significantly.
 Decreasing of IL-6 levels

C h a n g e s in IL - 6 le v e ls ( % )
Level of IL-6 mRNA is elevated in the conjunctival epithelium of patients
with dry eye disease.
6th months

0
-10
-20
-30
-40
-50
-54,72%
-60
IL-6 levels significantly decreased from baseline after 6 months of
treatment with %0.05 cyclosporine.
 Conjunctival staining scores
2.46
2.5

2
1.62
1.5
Before treatment
After treatment
1
0.55 0.48
0.5 0.29
0.18

0
Mild Moderate Severe
Study demonstrates that in patients who have dry eye symptoms and
are refractory to standard artificial tear therapy, cyclosporine may
alleviate signs and symptoms of the disease.
 Increase in Goblet cell counts

Increases in goblet cell density indicates a normalization of the ocular

surface and quality of the tear film.

Following 6-months cyclosporin treatment resulted in a

significant increase in goblet cells.
 Changes in OSDI scores

Patients were treated with

cyclosporine 0.05% or artificial
tears for 12 months. Dry eye signs
and symptoms were assessed by
the self-reported OSDI
questionnaire at indicated study
visits.
* P < 0.011 and ** P < 0.001
compared with patients treated
with artificial tears at months 8
and 12, respectively.

Cyclosporine 0.05% significantly increased tear production, decreased the

intensity of ocular staining, and decreased the severity of symptoms.
 Changes in Symptoms

Cyclosporine treatment in moderate to severe dry eye disease,

Dryness
Sandy/gritty feeling
Itching
Photophobia
Burning and stinging
Pain

Statistically significant changes were observed.

 “Dry eye” is a progressive disease1

Treatment with cyclosporine 0.05% may slow or prevent disease

progression in patients with dry eye at severity levels 2 or 3.

Patient with progressed disease

Cyclosporine 0.05% 6%
p<0.01

Artificial tears 32%

 Good tolerability profile

Larger clinical studies have also reported that cyclosporine

0.05% was well tolerated for up to 3 years with most
adverse events being transient in nature and mild to
moderate in severity.

These findings suggest that topical cyclosporine 0.05% is

safe for long-term use against dry eye disease.
 Maintaining the benefits gained therapeutically

Characterization of dry eye prognosis is, thus, the key to timely initiation and
maintenance of appropriate therapies to ensure prevention of disease
progression.

For maximal clinical response, using cyclosporine twice a day for about 1 year or
more should be required.
 DEPORES - Indications

DEPORES is indicated to increase tear production in patients

whose tear production is presumed to be suppressed due to
ocular inflammation associated with keratoconjunctivitis
sicca.
 DEPORES - Posology

Instill one drop of DEPORES twice a day in

each eye approximately 12-hour apart as
recommended dosage.
Thank you……

3 sachet, 30 single-use vial

Pregnancy category: C