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Does your eye get irritated or feel dry?

Most older people have at least some experience with dry eye, a condition that can require treatment and disrupt quality of life.

Dry eye is caused by inadequate tear production or inflammation in your eyes.

If you don’t know what Restasis is, you probably want to skip to the Cylcosporine part. This is a friendship post (in response to a friends question).

What is Restasis?

Restasis is an eye drop treatment that primarily consists of Cyclosporine.  See later for a discussion of how Cyclosporine works.  Restasis’s effectiveness has been shown in multiple studies for treatment of various eye conditions like keratoconjunctivitis.

Its use for irritation from contact lenses has not been extensively studied, and it seems that typical eye drops may work just as well.  Before using Restasis make sure it is 1) approved for your indication and that it is 2) more effective than less powerful treatments, and that you don’t have any conditions that mean you shouldn’t take it.

Restasis tends to work.  Some studies show 15% significant improvement, while other studies show 72.1% of patients with dry eye getting better to some degree.  In general, it seems that most Restasis users experience improvement.  Patience is key, because it takes several months to achieve a therapeutic effect.

Side effects of Restasis are mostly mild and consist of eye burning or blurring.  This is in contrast to corticosteriods, another treatment, which do have serious side effects, as well as most systemic drugs which effect the whole body.

Because Restasis is applied to the eye, and tends not to penetrate into the body, it seems to be safe.  That said, there are indications like infection and herpes which you need to tell your doctor because it may not be an appropriate medication then.

Use patterns of Restasis are not entirely clear.  Most users are over 50 and women, and it’s typically one of the first treatments sought.  While the manufacturer recommends using 2 vials daily, most users end up using from .25 a vial to 1.25 vials daily, but if this provides adequate treatment has not been medically evaluated.

Important issues

Whether cyclosporine is carcinogenic is a hottly debated topic in medicine.  What about Restasis?

A cursory look at the 58 articles found in pubmed for the search “Opthalmic Cyclosporine Cancer” shows that none talk about the potential of Restasis to cause cancer.

Several, however, talk about the use of cyclosporine to treat retinoblastomas, a serious type of eye cancer.

It’s important to note that blindness and other serious events have been reported in association with bone marrow transplants and Restasis use.

What is Cyclosporine?

Cyclosporine is a substance produced by the fungus Tolypocladium Inflatum, and is a powerful medication used to prevent organ rejection after transplant.  If you’re giving someone else’s kidney or heart, for instance, it can help stop your body from launching an attack on the new and foreign body part.

Because of how it works, Cyclosporine can also help with dry eye.

Cyclosporine does at least two important things.  It changes how T cells interact with IL-2, reducing its effectiviness.  IL-2, or interleukin-2, is a messenger protein that tells your T-cells to replicate.  Because T-cells play a key role in immune reactions, suppressing their growth can reduce the inflammation in your eye.

Cyclosporine may also help keep your eye healthy and strong.  The way it does this is by preventing essential lining cells from committing apoptosis – or cellular suicide.  Cells tend to commit apoptosis if their local environment becomes a war zone, so to speak, with a continual immune reaction causing too much stress.  Keeping epithelial cells alive also helps prevent further degeneration.

Sources:

Topical Ophthalmic Cyclosporine: Pharmacology and Clinical Uses

Can Restasis Help Dry-Eye Contact Lens Wearers?

Topical ciclosporin in the treatment of ocular surface disorders