Topical corticosteroids for dry eye

• Published in: Cochrane database of systematic reviews 2022-10, Vol.10 (10), p.CD015070
• Main Authors: Liu, Su-Hsun, Saldanha, Ian J, Abraham, Alison G, Rittiphairoj, Thanitsara, Hauswirth, Scott, Gregory, Darren, Ifantides, Cristos, Li, Tianjing
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - adverse effects; Adult; Cataract - drug therapy; Child; Child health; Child, Preschool; Cyclosporine - adverse effects; Dry Eye Syndromes - drug therapy; Eyes & vision; Female; Glucocorticoids - adverse effects; Humans; Loteprednol Etabonate; Lubricant Eye Drops; Male; Outer eye; Randomized Controlled Trials as Topic; Tobramycin
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD015070.pub2

Dry eye disease (DED), arising from various etiologic factors, leads to tear film instability, ocular surface damage, and neurosensory changes. DED causes symptoms such as ocular dryness, burning, itching, pain, and visual impairment. Given their well-established anti-inflammatory effects, topical steroid preparations have been widely used as a short-term treatment option for DED. Because of potential risks of ocular hypertension, cataracts, and infections associated with the long-term use of topical steroids, published trials comparing the efficacy and safety of topical steroids (versus placebo) have mostly been of short duration (three to eight weeks). To evaluate the effectiveness and safety of topical corticosteroids compared with no treatment, placebo, other steroidal or non-steroidal therapies, or a combination of therapies for DED. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; 2021, Issue 8); Ovid MEDLINE; Ovid Embase; Latin American and Caribbean Health Sciences database (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), without restriction on language or year of publication. The date of the last search was 20 August 2021. We included randomized controlled trials (RCTs) in which topical corticosteroids, alone or in combination with tobramycin, were compared with no treatment, artificial tears (AT), vehicles, AT plus tobramycin, or cyclosporine A (CsA). We applied standard Cochrane methodology. We identified 22 RCTs conducted in the USA, Italy, Spain, China, South Korea, and India. These RCTs reported outcome data from a total of 4169 participants with DED.  Study characteristics and risk of bias All trials recruited adults aged 18 years or older, except one trial that enrolled children and adolescents aged between 3 and 14 years. Half of these trials involved predominantly female participants (median 79%, interquartile range [IQR] 76% to 80%). On average, each trial enrolled 86 participants (IQR 40 to 158). The treatment duration of topical steroids ranged between one week and three months; trial duration lasted between one week and six months. Eight trials were sponsored exclusively by industry, and four trials were co-sponsored by industry and institutional or governmental funds. We assessed the risk of bias of both subjective and objective outcomes using RoB 2, finding nearly half of