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Related Experiment Video

Updated: Aug 24, 2025

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Topical corticosteroids for dry eye.

Su-Hsun Liu1, Ian J Saldanha2, Alison G Abraham3

  • 1Department of Ophthalmology, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.

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|October 21, 2022
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This summary is machine-generated.

Topical corticosteroids offer moderate symptom relief for dry eye disease (DED) compared to lubricants or cyclosporine A, but evidence on tear film quality and adverse effects remains uncertain. Further research is needed for optimal treatment strategies.

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Area of Science:

  • Ophthalmology
  • Clinical Trials
  • Pharmacology

Background:

  • Dry eye disease (DED) involves tear film instability, ocular surface damage, and neurosensory changes, causing symptoms like dryness, burning, and visual impairment.
  • Topical corticosteroids are used for short-term DED treatment due to anti-inflammatory effects, but long-term use carries risks like ocular hypertension and cataracts.

Purpose of the Study:

  • To evaluate the effectiveness and safety of topical corticosteroids for DED.
  • Comparisons included no treatment, placebo, other steroidal/non-steroidal therapies, or combination therapies.

Main Methods:

  • A systematic search of multiple databases (CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, ICTRP) was conducted up to August 20, 2021.
  • Included were 22 randomized controlled trials (RCTs) involving 4169 participants, comparing topical corticosteroids (alone or with tobramycin/CsA) against various controls.
  • Risk of bias was assessed using RoB 2, with nearly half of trials showing high risk due to selective outcome reporting.

Main Results:

  • Topical steroids likely provide small to moderate improvement in patient-reported DED symptoms (SMD 0.29) and corneal staining (SMD 0.4) versus lubricants (moderate certainty).
  • Steroids may slightly increase tear film break-up time (TBUT) but show no significant effect on tear osmolarity compared to lubricants.
  • Compared to cyclosporine A (CsA), steroids may offer small to moderate symptom relief but have little effect on corneal staining; effects on TBUT and osmolarity are uncertain.
  • Evidence on adverse effects, including intraocular pressure (IOP) elevation and cataract formation, is very uncertain due to short study durations and high risk of bias.

Conclusions:

  • Topical corticosteroids likely offer symptom relief for DED patients needing anti-inflammatory control, exceeding that of lubricants or CsA.
  • The evidence regarding steroids' effects on tear film quality/quantity and their long-term adverse effects (IOP, cataracts) is uncertain.
  • Future trials with robust methodology are needed to establish optimal corticosteroid regimens and understand their safety profile.