Management of Moderate-to-Severe Dry Eye Disease: Topical Cyclosporine Versus Lifitegrast

Abstract

Introduction: Dry eye disease (DED) affects 15-30% of adults. Topical anti-inflammatory drops (cyclosporine A 0.05%, lifitegrast 5%) are second-line after artificial tears, but comparative efficacy is unclear. Methods: Systematic review of 8 RCTs (n=3,452) with ≥12 weeks follow-up. Outcomes: corneal fluorescein staining (CFS, 0-4 scale), Schirmer's test (mm/5 min), Ocular Surface Disease Index (OSDI), tear break-up time (TBUT). Results: Both drugs improved CFS (cyclosporine: -1.3 points, lifitegrast: -1.4 points, p=0.71). OSDI improvement was comparable (-15 vs -16 points). Lifitegrast had faster onset (2 weeks vs 6 weeks, p=0.003) but higher transient instillation site irritation (32% vs 15%, p<0.001). Schirmer's improvement favored cyclosporine (+3.2 mm vs +1.8 mm, p=0.02). Discussion: Lifitegrast works via LFA-1 antagonism; cyclosporine via calcineurin inhibition. Different mechanisms may suit different DED subtypes. Conclusion: Both are effective. Lifitegrast offers faster relief but more stinging. Cyclosporine may be better for aqueous-deficient DED.