Which topical ophthalmic drugs work best for Keratoconjunctivitis Sicca? A systematic review and meta-analysis

Dry Eye Disease (DED) is a chronic and multifactorial condition that significantly impacts patient quality of life. Topical ophthalmic drugs (TODs) have emerged as key treatments for DED, offering the potential to address the underlying pathology rather than merely alleviating symptoms. This review aims to assess the efficacy of various TODs in managing the symptoms of DED.

A comprehensive search was conducted across three electronic databases to identify relevant articles for inclusion in this review. Two independent authors screened the articles according to predefined eligibility criteria. A total of 16 randomized controlled trials (RCTs) were included, summarizing data from 2,680 patients. The data were analyzed using Review Manager 5.4, with pooled analysis conducted on key symptoms including corneal fluorescein staining (CFS), Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), and Schirmer test scores.

From 632 articles identified, 16 RCTs were selected for inclusion. The pooled analysis revealed that cyclosporine therapy resulted in a significant improvement in CFS scores (mean difference (MD) -0.24; 95% confidence interval (CI) (-0.42, -0.07), P = 0.006). However, no significant improvements were observed in OSDI, TBUT, or Schirmer test scores (MD -0.35; 95% CI (-5.66, 4.96), P = 0.9; MD 0.12; 95% CI (-0.65, 0.89), P = 0.76; MD -0.22; 95% CI (-0.46, 0.02), P = 0.07, respectively). Similar results were found for loteprednol etabonate (LE) and diquafosol sodium, with no significant changes in OSDI, CFS, or Schirmer test scores. For diquafosol, no significant improvements were observed in any of the DED symptoms, including OSDI (MD -3.82; 95% CI (-8.31, 0.67), P = 0.10), CFS (MD -0.31; 95% CI (-0.82, 0.20), P = 0.23), TBUT (MD -0.20; 95% CI (-1.37, 0.98), P = 0.74), and Schirmer test (MD -1.00; 95% CI (-2.60, 0.60), P = 0.22).

The study concluded that cyclosporine therapy offers improvements in corneal fluorescein staining but does not significantly affect other common DED symptoms, such as OSDI, TBUT, and Schirmer test scores. Similarly, no significant improvements in DED symptoms were observed with loteprednol etabonate or diquafosol sodium. Further research is needed to explore the efficacy of these treatments in managing DED symptoms more comprehensively.