Advancing Care for Dry Eye and Corneal Conditions

New perspectives in dry eye care—ranging from cyclosporine ophthalmic solution 0.09% for uncontrolled cases to the innovative use of scleral lenses for patients with chronic dry eye and Salzmann nodular degeneration—take center stage in the posters presented at the Southeastern Congress of Optometry (SECO) 2025.

Over 58% of people experience some form of dry eye symptoms, of whom about 30% have moderate dry eye and 12% have severe dry eye.⁴ | Image credit: mputsylo - stock.adobe.com

Cyclosporne Eye Drops for Uncontrolled Dry Eye Disease

The use of cyclosporine ophthalmic solution 0.09% (Cequa), administered twice daily, resulted in statistically significant improvements in chronic fatigue syndrome (CFS) scores among patients with dry eye disease, regardless of whether they also had meibomian gland dysfunction (MGD), researchers found.

The results from a phase 4, multicenter, single arm, 12-week study (NCT04357795) assessed cyclosporine 0.09% for patients with dry eye disease that was inadequately controlled by cyclosporine 0.05% (Restasis). For inclusion, patients had to have dry eye disease for at least 3 months, have their CFS and best corrected visual acuity scores within certain parameters, and discontinue all other dry eye disease therapy outside of artificial tears.

Assessments for how cyclosporine 0.09% performed were made at weeks 4, 8, 12, and/or on early termination. Overall, 124 patients were included (mean [SD] age, 65.6 [11.5]; female, 87.9%; White, 87.9%).

The mean baseline total CFS score was 5.34 (3.42) in patients without MGD (n = 94), showing statistically significant improvement by week 12 (mean CFS score, 2.62 [2.49]). Patients with MGD (n = 30) also experienced statistically significant improvement in CFS scores (mean CFS score, 6.88 [2.98] at baseline vs 2.97 [1.96] at week 12).

Results also showed significant improvements in corneal staining and tear production, with effects observed as early as week 4 and maintained through week 12. Patients reported reduced reliance on artificial tears, and a majority preferred cyclosporine 0.09% over cyclosporine 0.05%. The treatment was well tolerated, with no new safety concerns.

Scleral Lenses for Salzman Nodular Degeneration

Highly customizable scleral lenses have shown to be a great nonsurgical intervention to help manage symptomatic Salzman nodular degeneration,² a slowly progressive corneal condition characterized by elevated nodules on the cornea, often affecting both eyes.³

Patients with chronic dry eye, blepharitis, trichiasis, previous ocular trauma, post-surgical changes, and systemic conditions like Crohn disease are at a higher risk of developing Salzman nodular degeneration. Additional risk factors include contact lens use and corneal vascularization.

The poster looked at a case study of a 52-year-old White woman who presented with Salzmann nodular degeneration and dry eye syndrome.² During the assessment of this patient, it was determined that she also had myopia, irregular astigmatism, presbyopia, superficial punctate keratitis, and corneal neovascularization. Doctors recommended the patients be fit for scleral lenses to improve the patient’s visual clarity and comfort.

Four pairs of scleral lenses were tested before finding the right fit for the patient, opting for lenses made out of optimum infinite, filled with nonbuffered sterile saline solution to assess ocular surface response, and that wear time of 30 minutes to 4 hours per day before reassessment.

Overall, the patient had a good experience with the scleral lenses, improving her comfort, relieving her dry eye, and enhancing her vision. However, she couldn’t get past being constantly aware of the lenses, and although her vision had improved, it was still unstable. Additionally, researchers lost the patient to follow-up before being able to finalize their conclusions.

Study authors provided recommendations for optometrists when looking to use scleral lenses, including considering using a larger lens, oblate shares, quadrant-specific peripheral curve changes, and microvaults to clear peripheral nodules, stressing the importance of avoiding the one-size-fits-all approach.

References

1. Johnston J, Adler R, Hessen M, et al. Efficacy of cyclosporine ophthalmic solution 0.09% in patients with uncontrolled dry eye disease: A subgroup analysis in patients with or without meibomian gland dysfunction. Presented at: SECO 2025; February 26-March 2, 2025; Atlanta, GA. Poster 133. https://seco2025posters.s3.amazonaws.com/johnston_efficacy/index.html

2. Chao HA, Nguyen T-L, Zubkousky S, Janoff A, Khan A. Harnessing scleral lenses to manage Salzmann nodular degeneration complications. Presented at: SECO 2025; February 26-March 2, 2025; Atlanta, GA. Poster 28. https://seco2025posters.s3.amazonaws.com/chao_harnessing/index.html

3. Sirajeldin A, Hwang FS. Salzman nodular degeneration. EyeWiki by the American Academy of Ophthalmology. Updated February 11, 2025. Accessed March 1, 2025. https://eyewiki.org/Salzmann_Nodular_Degeneration