Ophthalmic cyclosporine is a type of drug that helps to increase tear production in those who have dry eye syndrome, or DES. It is a type of medication that is part of the immunomodulator family. This means that it decreases any swelling in the eye, enabling it to produce more tears while making the tears of higher quality.

What Is Cyclosporine and How Does It Work?

Cyclosporine for the eyes has been manufactured under the name Restasis. The goal of Restasis ophthalmic emulsion is to enable patients to increase the natural ability of the eyes to produce tears. It is most common as a form of treatment for chronic dry eye, which usually happens as a result of inflammation.

Cyclosporine can be used orally and intravenously as well. In these cases, it is available in a different formulation and is prescribed to treat or prevent transplanted organ rejection, rheumatoid arthritis, and psoriasis. Significant and serious side effects, including an increased risk of developing skin cancer, are associated with this type of cyclosporine usage, but they are not associated with the eye drops. When orally or intravenously used, cyclosporine suppresses the natural immune system of the body.

The eye drop emulsion works very differently, however. It is understood that, when applied locally to the eye, it only partially modulates the body’s natural immune system. The immune system is made up of various components and one of them are the white blood cells known as lymphocytes. When lymphocytes die, they start to accumulate within the eyes’ tear glands, which leads to a decreased tear production. What Restasis does is reverse this, thereby also increasing tear production.

Unfortunately, the effects of Restasis can take quite a long time to materialize. It could take so long, in fact, that many people cease the treatment before they notice the benefits. This is also because the side effects associated with cyclosporine eye drops are common and quite uncomfortable (more on that later). Usually, it takes between three and six months before any positive effects are noticed, which is simply too long for some people, particularly because of the side effects.

The U.S. Food and Drug Administration approved Restasis cyclosporine eye emulsion in January 2003. To date, it is the only approved medication of its kind. However, due to its side effects and the fact that it takes so long to take effect, significant efforts are being made to develop other types of medication, so far with varying results.

How to Use Cyclosporine

Cyclosporine is available as a liquid emulsion that can be placed in the eye. Usually, you have to do this twice per day, with a 12 hour gap. It is important to use the drops around the same time every day, and to properly follow all the instructions provided with the product. Cyclosporine is a prescription medication, and you must follow the label. Don’t be afraid to speak to your pharmacist or ophthalmologist if you have any questions.

You should not deviate from the provided instructions. As such, they should only be used in the eye. No skin contact should be allowed, nor should you swallow the drug. The medicine should be provided in single dosage vials, and it should be used immediately after opening.

To apply cyclosporine, you should:

• Thoroughly clean your hands with soap and water.
• Rotate the vial so that the liquid is no longer see-through but turns white.
• Open the bottle.
• Make sure the dropper is completely clean and avoid direct contact with the surface of the eye or skin.
• Tilt your head back and pull on your lower lid so that a pocket is formed.
• Place the tip of the dropper as close to the pocket as possible, look up, and squeeze one drop in the pocket.
• Close your eye and keep it closed for around three minutes, tilting your head down. Do not blink or squeeze.
• Apply gentle pressure to the tear duct by placing a finger on it.
• Use a clean tissue to wipe any excess liquid off the surrounding area.
• Wait five minutes before applying a second drop, if you have been prescribed a higher dosage.
• Throw away the vial, even if some liquid remains.
• Wash your hands with soap and water again.

Special Precautions to Follow with Cyclosporine

Before you use cyclosporine, you should:

• Make sure you tell your ophthalmologist or doctor if you have any allergies.
• Tell your prescribing physician whether you are currently taking other medication, including over the counter, supplemental, and herbal medicine.
• Wait 15 minutes between applying cyclosporine and any other eye drops.
• Tell your prescribing physician if you have had herpes of the eye or if you currently have a punctal plug or eye infection.
• Tell your doctor if you are trying to conceive, currently pregnant, or are nursing.
• Do not wear contacts while using cyclosporine. If you are wearing them, remove them before you use the drops, and wait 15 minutes before replacing them.

Cyclosporine Side Effects

Most of the side effects of cyclosporine are minor and only last for a short while. However, if you are worried if the side effects become unmanageable, or if they don’t improve or even worsen over time, you should contact your doctor.

The most common side effects associated with cyclosporine use are:

• An overproduction of tears that overflows
• Pain, redness, stinging, itching, or burning of the eyes
• Discharge from the eye
• Eye redness
• Feeling like there is a foreign object in the eye
• Vision changes, particularly blurred vision

Other side effects are possible, and it is important to always contact your doctor if you have any concerns.

One of the issues with cyclosporine is that these side effects are incredibly common. While not dangerous, they are uncomfortable. Because it can take so long for the positive effects of cyclosporine to be noticed, many people struggle to keep up with the recommended treatment.

Resources and References:

Cyclosporine Ophthalmic – Information on how this drug is prescribed, used, etc. (MedlinePlus.gov)

National Institutes of Health – Long-term Safety and Efficacy of Topical Cyclosporine in 156 Children with Vernal Keratoconjunctivitis (NIH.gov)

Restasis – Information on Restasis Ophthalmic Emulsion (Restasis.com)