Intervention with cyclosporine A stabilizes tear film and relieves asthenopia in mild dry eye with short fluorescein tear break-up time : A randomized controlled trial

Cont Lens Anterior Eye. 2025 Apr;49(2):102625. doi: 10.1016/j.clae.2026.102625. Epub 2026 Feb 1.

ABSTRACT

BACKGROUND: This study aims to compare therapeutic effects of 0.1% sodium hyaluronate (SH) and 0.05% cyclosporine A (CsA) eye drops on dry eye and asthenopia in patients with mild dry eye combined with short fluorescein tear break-up time (FBUT).

METHODS: 60 eligible subjects were recruited and ultimately 55 subjects completed all four visits throughout the entire process. Patients with mild dry eye and short FBUT (2-5 s) were randomly, assigned to either a sodium hyaluronate group (Group A) or a cyclosporine A group (Group B) and received eye drop treatment for 8 weeks. Dry eye symptoms were assessed using OSDI, Schirmer test, FBUT, TMH, NIBUT, and bulbar redness. Asthenopia was evaluated using ASQ-17 and high-frequency components (HFC) of accommodative microfluctuations. Measurements were taken at baseline and after 1, 4, and 8 weeks of treatment.

RESULTS: Both CsA and SH improved OSDI and FBUT. Compared to SH, CsA showed a more sustained FBUT improvement from week 4 to week 8 (95%CI [0.90,2.52], P < 0.001). Asthenopia, assessed by HFC and ASQ-17, was also more significantly reduced in Group B at week 8 from baseline (HFC 95%CI [-4.10,-0.76], P = 0.002; ASQ-17 95%Cl [-13.52,-6.13], P < 0.001). FBUT improvement was significantly correlated with HFC reduction (Standardized coefficients = -0.39,P = 0.01).

CONCLUSIONS: CsA and SH can both improve the symptoms and signs of patients with mild dry eye syndrome. However, the therapeutic effect of CsA on such patients is more lasting, and it has an alleviating effect on asthenopia. The mechanism may be to increase the FBUT and thereby stabilize the tear film.

PMID:41628505 | DOI:10.1016/j.clae.2026.102625