The Comparison Between the Efficacy of Topical Corticosteroids vs Topical Cyclosporine A in Treating Dry Eye in Sjögren Syndrome

Abstract

Introduction: Sjögren's syndrome is a chronic systemic autoimmune disease that primarily affects the exocrine glands, particularly the lacrimal and salivary glands, leading to dry eye (keratoconjunctivitis sicca) and dry mouth (xerostomia). Dry eye symptoms are experienced by the majority of Sjögren's patients and can significantly impact quality of life. One of the main challenges in its management is selecting a topical anti-inflammatory therapy that is both effective and safe. Two commonly used treatments are topical corticosteroids and topical cyclosporine A; however, their efficacy and tolerability remain a subject of debate. Therefore, this review aims to discuss the effectiveness, safety, and tolerability of these treatment options.

Method: This narrative literature review was conducted using sources from PubMed, Scopus, and Google Scholar for publications from 2015 to 2025. Inclusion criteria covered articles in English or Indonesian that examined the use of either or both therapies in treating dry eye (DE) associated with Sjögren's syndrome. Studies focusing on non-autoimmune DE or systemic therapies without a topical focus were excluded. Relevant literature was analyzed qualitatively to evaluate the efficacy and limitations of each treatment approach.

Discussion: Various studies have shown that the use of topical corticosteroids and topical cyclosporine A has differing effectiveness in managing dry eye in patients with Sjögren’s syndrome. Corticosteroids such as fluorometholone and loteprednol have been proven to provide faster symptom relief, particularly during the acute inflammatory phase. However, their use is limited by long-term side effects such as increased intraocular pressure and the risk of cataracts. On the other hand, cyclosporine A has advantages in gradually reducing inflammatory activity, is safe for long-term therapy, and is effective in reducing immune cell infiltration, such as dendritic cells on the corneal surface. Several studies also support that a combination of corticosteroids and cyclosporine A can produce synergistic effects, accelerating symptom improvement without compromising long-term safety. Therefore, therapy selection should be adjusted according to the disease phase, severity of symptoms, and the risk–benefit profile of each agent.

Conclusion: Topical corticosteroids are effective in relieving symptoms during the acute inflammatory phase of Sjögren's syndrome-related dry eye rapidly, but they are recommended only for short-term use. Cyclosporine A is safer for long-term therapy due to its immunomodulatory effects. The combination of both agents provides a synergistic benefit. Treatment selection should be tailored to the disease phase and the patient's risk profile.