Efficacy, safety, and tolerability of pharmacological treatments for moderate-to-severe dry eye disease: systematic review of randomized controlled trials


  • Carolyn Yu Tung Wong +852 5326 3232
  • Justin Man Kit Tong Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China


Cyclosporine, Dry eye syndromes, Hyaluronic acid, Lifitegrast, Ophthalmic solutions


Dry eye disease (DED) is characterized by impaired tear film homeostasis and ocular surface inflammation. Topical ocular medications for moderate-to-severe DED include hyaluronic acid (HA), cyclosporine A (CsA), serum eyedrops (SE), and lifitegrast. Effective HA-based formulations and regimens include topical aqueous HA 0.15% and 0.18%, HA gel 0.30%, sequential administration of HA 0.30% and 0.15%, a combination of HA 0.15% and polyethylene glycol, and multi-agent eyedrops containing 0.15% HA. Preservative-free hydrocortisone and loteprednol, known as soft steroids, are effective and have a reduced risk of steroid-related adverse effects. Effective CsA formulations include 0.05% CsA gel, CsA nanoemulsions, water-free CsA, and CsA combinations with lubricants (eg, HA). Autologous, allogeneic, and umbilical cord serum eyedrops, as well as the novel lymphocyte function-associated antigen-1 antagonist lifitegrast, are also effective. Various treatment options may improve treatment adherence. Long-term and large-scale studies are required to confirm the therapeutic efficacies of these treatments.



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How to Cite

Wong CYT, Tong JMK. Efficacy, safety, and tolerability of pharmacological treatments for moderate-to-severe dry eye disease: systematic review of randomized controlled trials. Hong Kong J Ophthalmol [Internet]. 2024May9 [cited 2024Jul.14];28(1). Available from: https://hkjo.hk/index.php/hkjo/article/view/383