Analysis of topical cyclosporine treatment of patients with dry eye syndrome - Effect on conjunctival lymphocytes

Objective: To study the effect of topical cyclosporine on lymphocyte activa tion within the conjunctiva of patients with moderate to severe dry eye syn drome (Sjogren and non-Sjogren). Methods: Biopsy specimens were obtained at baseline and after 6 months of c yclosporine treatment from eyes of 32 patients with moderate to severe dry eye syndrome; 19 were cyclosporine treated (0.05% cyclosporine, n=13; 0.1% cyclosporine, n=6) and 13 were vehicle treated. Within this group there wer e 12 with Sjogren syndrome and 20 with non-Sjogren syndrome. Biopsy tissue was analyzed using immunohistochemical localization of binding of monoclona l antibodies to lymphocytic markers CD3, CD4, and CD8 as well as lymphocyte activation markers CD11a and HLA-DR. Results: In cyclosporine-treated eyes, biopsy results of conjunctivae showe d decreases in the number of cells positive for CD3, CD4, and CD8, while in vehicle-treated eyes, results showed increases in these markers, although these differences were not statistically significant. Following treatment w ith 0.05% cyclosporine, there was a significant decrease in the number of c ells expressing the lymphocyte activation markers CD 11a (P<.05) and HLA-DR (P<.05), indicating less activation of lymphocytes as compared with vehicl e treatment. Within the Sjogren patient subgroup, those treated with 0.05% cyclosporine also showed a significant decrease in the number of cells posi tive for CD11a (P<.001) as well as CD3 (P<.03), indicating a reduction in n umber of activated lymphocytes. Conclusion: Treatment of dry eye syndrome with topical cyclosporine signifi cantly reduced the numbers of activated lymphocytes within the conjunctiva.