Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease
Immunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the c...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Indian Journal of Ophthalmology |
| Subjects: | |
| Online Access: | http://www.ijo.in/article.asp?issn=0301-4738;year=2023;volume=71;issue=4;spage=1176;epage=1189;aulast=Kate |
| _version_ | 1797824288215007232 |
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| author | Anahita Kate Swapna S Shanbhag Pragnya R Donthineni Guillermo Amescua Victor L Perez Quinones Sayan Basu |
| author_facet | Anahita Kate Swapna S Shanbhag Pragnya R Donthineni Guillermo Amescua Victor L Perez Quinones Sayan Basu |
| author_sort | Anahita Kate |
| collection | DOAJ |
| description | Immunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the choice of one drug over the other is determined by the underlying systemic disease. These immunosuppressive agents require a minimum of 6–8 weeks to achieve their beneficial effect, and during this time, the patient is usually placed on topical corticosteroids. Antimetabolites such as methotrexate, azathioprine, and mycophenolate mofetil, along with calcineurin inhibitors, are commonly used as first-line medications. The latter have a pivotal role in immunomodulation since T cells contribute significantly to the pathogenesis of ocular surface inflammation in dry eye disease. Alkylating agents are largely limited to controlling acute exacerbations with pulse doses of cyclophosphamide. Biologic agents, such as rituximab, are particularly useful in patients with refractory disease. Each group of drugs has its own side-effect profiles and requires a stringent monitoring schedule that must be followed to prevent systemic morbidity. A customized combination of topical and systemic medications is usually required to achieve adequate control, and this review aims to help the clinician choose the most appropriate modality and monitoring regimen for a given case of ADDE. |
| first_indexed | 2024-03-13T10:36:44Z |
| format | Article |
| id | doaj.art-1cd12edb3bca4c2b910959bfc7032356 |
| institution | Directory Open Access Journal |
| issn | 0301-4738 1998-3689 |
| language | English |
| last_indexed | 2024-03-13T10:36:44Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Ophthalmology |
| spelling | doaj.art-1cd12edb3bca4c2b910959bfc70323562023-05-18T05:50:41ZengWolters Kluwer Medknow PublicationsIndian Journal of Ophthalmology0301-47381998-36892023-01-017141176118910.4103/IJO.IJO_2818_22Role of topical and systemic immunosuppression in aqueous-deficient dry eye diseaseAnahita KateSwapna S ShanbhagPragnya R DonthineniGuillermo AmescuaVictor L Perez QuinonesSayan BasuImmunosuppression in aqueous-deficient dry eye disease (ADDE) is required not only to improve the symptoms and signs but also to prevent further progression of the disease and its sight-threatening sequelae. This immunomodulation can be achieved through topical and/or systemic medications, and the choice of one drug over the other is determined by the underlying systemic disease. These immunosuppressive agents require a minimum of 6–8 weeks to achieve their beneficial effect, and during this time, the patient is usually placed on topical corticosteroids. Antimetabolites such as methotrexate, azathioprine, and mycophenolate mofetil, along with calcineurin inhibitors, are commonly used as first-line medications. The latter have a pivotal role in immunomodulation since T cells contribute significantly to the pathogenesis of ocular surface inflammation in dry eye disease. Alkylating agents are largely limited to controlling acute exacerbations with pulse doses of cyclophosphamide. Biologic agents, such as rituximab, are particularly useful in patients with refractory disease. Each group of drugs has its own side-effect profiles and requires a stringent monitoring schedule that must be followed to prevent systemic morbidity. A customized combination of topical and systemic medications is usually required to achieve adequate control, and this review aims to help the clinician choose the most appropriate modality and monitoring regimen for a given case of ADDE.http://www.ijo.in/article.asp?issn=0301-4738;year=2023;volume=71;issue=4;spage=1176;epage=1189;aulast=Katecalcineurin inhibitorscorticosteroidsdry eye diseaseimmunosuppressive agentsmucous membrane pemphigoidsjogren's syndromesteroid-sparing agents |
| spellingShingle | Anahita Kate Swapna S Shanbhag Pragnya R Donthineni Guillermo Amescua Victor L Perez Quinones Sayan Basu Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease Indian Journal of Ophthalmology calcineurin inhibitors corticosteroids dry eye disease immunosuppressive agents mucous membrane pemphigoid sjogren's syndrome steroid-sparing agents |
| title | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
| title_full | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
| title_fullStr | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
| title_full_unstemmed | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
| title_short | Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease |
| title_sort | role of topical and systemic immunosuppression in aqueous deficient dry eye disease |
| topic | calcineurin inhibitors corticosteroids dry eye disease immunosuppressive agents mucous membrane pemphigoid sjogren's syndrome steroid-sparing agents |
| url | http://www.ijo.in/article.asp?issn=0301-4738;year=2023;volume=71;issue=4;spage=1176;epage=1189;aulast=Kate |
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