Efficacy and Safety of Topical Chloroquine in Mild to Moderate Dry Eye Disease

• Published in: Current eye research 2019-12, Vol.44 (12), p.1306-1312
• Main Authors: Titiyal, Jeewan S., Kaur, Manpreet, Falera, Ruchita, Bharghava, Ashima, Sah, Ramkishor, Sen, Seema
• Format: Article
• Language: English
• Subjects: anti-inflammatory therapy; Antirheumatic Agents - administration & dosage; Chloroquine - administration & dosage; Conjunctiva - pathology; Dose-Response Relationship, Drug; Dry eye disease; Dry Eye Syndromes - diagnosis; Dry Eye Syndromes - drug therapy; Female; Humans; impression cytology; Male; Middle Aged; Ophthalmic Solutions; Pilot Projects; Prospective Studies; Severity of Illness Index; Topical Chloroquine; Treatment Outcome
• ISSN: 0271-3683; 1460-2202
• DOI: 10.1080/02713683.2019.1641824

Purpose: To evaluate the role of topical chloroquine (CHQ) as an adjunct to topical lubricants in the management of mild-moderate dry eye disease (DED) Methods: Prospective comparative pilot study allocated 150 patients with symptoms of mild to moderate DED to receive topical CMC 0.5% three times a day (group I, n = 75) or topical CHQ 0.03% twice a day with carboxymethylcellulose (CMC) 0.5% three times a day (group II, n = 75), for three months. Primary outcome measures were ocular surface disease index (OSDI) score and conjunctival impression cytology at 3 months. Secondary outcome measures were TBUT, Schirmer's test, ocular surface staining and any adverse effects at 3 months. Follow up was performed at 1 and 3 months. Results: At three months, the OSDI score was significantly better in the CHQ group as compared with the CMC group (CMC-18.36 ± 4.03 (SD), CHQ group- 15.9 ± 5.18 (SD); p = .002). Nelson's score was 0.92 ± 0.69 (SD) in the CHQ group as compared with 1.60 ± 0.77 (SD) in the CMC group (p < .001). Abnormal impression cytology was observed in 20% cases in the CHQ group as compared with 61.3% cases in CMC group (p < .001). A significant correlation was observed between Nelson's score and OSDI (Spearman's rho correlation coefficient 0.414, p < .001). TBUT, Schirmer test and ocular surface staining were significantly better in the CHQ group (p < .001). No adverse effects were observed in any group. Conclusion: Topical chloroquine is a useful adjunct to topical lubricants in the management of DED as it decreases the underlying chronic inflammation and helps maintain ocular surface stability.