Restasis ( Cyclosporine A) for dry eye


Restasis (cyclosporine A 0.05%) is a drop approved by the FDA to treat chronic dry eye. It is approved for long term use which mirrors the chronic nature of dry eye. It is thought to increase the tear gland’s ability to produce more tears. It does this by suppressing inflammation which reduces tear production.

The drops are used 2 times per day and they come in unpreserved single dose units. Some patients start to notice an effect after a month, but typically it takes a few months for the effects to show. It has to be used consistently and the benefits stop if the drops are discontinued.

Typically, Restasis is started at the same time as steroid eye drops and after a few weeks the steroid drops are tapered away and the Restasis is continued. Steroids are only suitable for short-term use because over the long term they can cause eye pressure to go up, cataracts and increase susceptibility to infection. The idea behind this approach is to break the cycle of inflammation quickly and then let the Restasis do its job.

The most common side effect is burning on instillation ( 17% of patients). Some find this so irritating that they give up on the drops. In the USA Lotemax is used to help stop the stinging in the initial weeks of the treatment. It has been shown to reduce the stinging  by up to 75%.

One of the commonest reasons patients give up on Restasis is that they  do not notice any immediate effects. The second reason is the burning and stinging that occurs for 17% of patients. This improves over time and is mostly gone by 3 months of use.

Restasis is not readily available in Australia.  It can be compounded by a compounding pharmacy. The typical cost would be around $100 for a 1 month supply.

Restasis can be accessed via the TGA special access system. This involves a lot of paperwork and is not often done.