Eye Burning with Restasis (Cyclosporine) Eye Drops: Causes and Management

the causes and management of eye burning, stinging and pain with restasis cyclosporine eye drops

Cyclosporine eye drops are a powerful and effective medication for the management of dry eye disease.

While it has shown great promise in improving ocular health, a frequently reported side effect is eye burning after instillation. The burning from the drops may start immediately after beginning treatment or may develop days to weeks later.

This article aims to explore the causes, symptoms, and management strategies for eye burning associated with the use of cyclosporine eyedrops.

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What is Cyclosporine?

Cyclosporine is a type of medication that belongs to a group of drugs called immunosuppressants. These drugs work by reducing the activity of immune cells in the body.

Cyclosporine specifically acts on the type of immune cells called “T-cells” or “Thymus-derived cells”. It prevents these cells from releasing chemicals that cause inflammation. By reducing the activity of these cells, cyclosporine helps control inflammation in the body.

Cyclosporine can be taken by mouth or through injections to treat immune system diseases like rheumatoid arthritis, inflammatory bowel disease, and psoriasis. Additionally, it helps prevent rejection in individuals who have received organ transplants.

Cyclosporine is also used to treat various eye conditions like dry eye syndrome, allergic conjunctivitis, uveitis, and the prevention of corneal graft rejection. For the treatment of eye diseases, it is usually used in the form of eye drops. However, if eye disease is caused by a systemic disorder, cyclosporine may be used orally or through injection as well.

How do Cyclosporine Eye Drops Help with Dry Eye Disease?

Dry eye disease occurs when the tears on the surface of the eye evaporate too quickly or when the eye doesn’t produce enough tears.

In both cases, a lack of tears causes drying and irritation of the surface of the eye. This irritation triggers a response from the immune system of the body. White blood cells, which are part of the immune system, are activated and recruited to the surface of the eye.

White blood cells release chemicals that cause damage to the cells covering the surface of the eye and make the tear film unstable and too concentrated. This causes worsening of the irritation and the recruitment of more white cells.

The chemicals released also damage the glands that produce tears, causing a further reduction in tear production. This creates a vicious cycle where dry eye worsens inflammation, and inflammation worsens dry eye.

A specific type of white blood cell called the T-cell plays a major role in causing dry eye. Cyclosporine works by inhibiting T cells from releasing substances that cause inflammation. By doing so, it breaks the cycle of inflammation and helps to improve the symptoms of dry eye.

There are more ways that cyclosporine helps with dry eye. It works by increasing the quantity of goblet cells, which are cells on the surface of the eye that produce a component of tears called mucin. This keeps the tear film healthy and the surface of the eye lubricated.

Cyclosporine also has the ability to prevent cell death on the surface of the eye. This helps in reducing irritation and inflammation, which stops immune cells from releasing more chemicals.

Common Side Effects of Cyclosporine Eye Drops

Despite being very effective in treating dry eye disease, cyclosporine eye drops often have a few minor local side effects.

When using cyclosporine eye drops, the following side effects are frequently reported:

  • Burning or stinging of the eyes
  • Redness of the eyes
  • The sensation of having something in the eye
  • Eye pain
  • Blurring of vision (temporary)
  • Watering of the eye
Causes of Eye Burning with Cyclosporine Eye Drops

The most common side effect that occurs with the use of cyclosporine eye drops is burning or stinging.

This side effect can be bothersome for those using the eye drops and varies in severity from person to person. It may result from one or more of the following reasons:

Formulation factors

Ocular burning can be caused by the specific formulation of cyclosporine eye drops.

Cyclosporine doesn’t dissolve well in water, so it is mixed with ingredients to help it stay in the water. Some of these ingredients can make the eyes burn for some people.

Different brands or types of eye drops can have different levels of these ingredients, which may cause irritation or sensitivity for some individuals.

Individual sensitivity

Each person’s eyes are different, and some people may be more likely to experience eye burning from cyclosporine eye drops.

If you have other pre-existing eye problems, allergies, or have very sensitive eyes, you might have a higher chance of experiencing eye burning.

Initial treatment period

Eye burning can be more noticeable when you initially start using cyclosporine eye drops. This happens because your eyes need time to get used to the medication.

Furthermore, the eye drops will sting because your eye surface is already damaged before starting treatment. Usually, this side effect gets better as you continue the treatment and the surface of the eye starts to get healthier.

Concentration of cyclosporine

Cyclosporine eye drops come in different concentrations. Higher concentrations of cyclosporine in eye drops may increase the risk of ocular burning. Reducing the dose may help improve burning if other measures do not help.

Application technique

Using cyclosporine eye drops incorrectly, like using too much or too little, can cause eye burning. It’s important to follow the prescribed dosage instructions and apply the drops correctly.

Treatment for Eye Burning with Cyclosporine Eye Drops

Stinging or burning of the eyes from the use of cyclosporine eye drops can cause considerable discomfort for some people.

Use the following measures to help with eye burning from cyclosporine eye drops so you may be able to continue treatment without difficulty and experience improvement in your eye health:

Use of artificial tear eye drops

Applying artificial tears (any lubricant eye drops) 5–10 minutes before using cyclosporine can help lessen the burning sensation caused by the medication.

In people with dry eye disease, the eye surface is damaged, leading to stinging when using medications. Using lubricating eye drops moisturizes and soothes the irritated eye, reducing the burning sensation from applying cyclosporine.

Chilling the medication

To help ease the burning sensation, you can refrigerate the medication before using it. The medication leaflet suggests storing cyclosporine eye drops at room temperature. However, the medication can also be refrigerated and cooled if needed. Cooling it will not change the effectiveness of the medication.

Using cool compresses

Applying a cool compress to the eyes after putting in topical cyclosporine eye drops can provide relief from ocular burning. Use a clean, soft cloth soaked in cool water and gently place it over closed eyelids for a few minutes to help relieve burning.

Avoiding eye irritants

Eyes with dry eye disease are already irritated and sensitive to irritants. Avoid exposing your eyes to things that can make the burning worse, like smoke, dust, and harsh chemicals.

Patience and persistence

The burning experienced with cyclosporine eye drops decreases with continued, regular use of the medication. As the surface of the eye becomes healthier, it is better able to tolerate the medication.

Using with steroid eye drops

If the burning sensation is too much for you, your doctor may prescribe a topical steroid eye drop to be used with cyclosporine eye drops for a few weeks. This can help reduce eye inflammation faster and relieve the burning sensation caused by cyclosporine.

If your eye surface is too inflamed, your doctor might even prescribe you steroid eye drops to be used a couple of weeks before starting treatment with cyclosporine eye drops.

Caution: Always use steroid eye drops under your doctor’s guidance as prolonged use can lead to serious complications like cataracts and glaucoma.

Trying a different formulation

Cyclosporine eye drops are made with ingredients to help them mix with water, but some of these ingredients can cause eye burning for some people.

Different brands or types of eye drops may have varying levels of these ingredients. Trying out a different preparation may result in improved eye burning for some individuals.

Seeking alternative treatments

If your eye burning does not improve even after trying the above methods, it’s best to talk to your healthcare provider about other treatment options. They might suggest different medications or therapies, like autologous serums, bandage contact lenses, Liftegrast eye drops, or even surgery, that can improve your eye condition without causing discomfort.

Other side effects of cyclosporine eye drops

Some people experience redness of the eyes from the irritation that the drops cause.

Irritation from the drops can sometimes also cause reflex watering. This is a reaction of the eye to irritation in an attempt to flush out the irritant.

With proper management of stinging and burning, as mentioned above, the redness and watering also settle.

A few describe the irritation as pain instead of burning. If you are experiencing pain in your eye after eye drop instillation, it is best to get checked by your doctor to make sure the pain is not from any other cause.

Temporary blurring of vision occurs with the medication as it is held in an oily medium. The blurring usually clears in a couple of minutes.

Frequently Asked Questions (FAQs)

FAQ 1: Is eye burning with cyclosporine eye drops permanent?

Usually, eye burning from cyclosporine eye drops is temporary and goes away with time, proper management, or stopping the treatment. But if the symptoms continue or get worse, it’s important to consult your healthcare provider for further evaluation.

FAQ 2: Is eye burning a common side effect of cyclosporine eye drops?

Eye burning is a known side effect of cyclosporine eye drops but may not occur in every individual using the medication. Eye burning can differ in how often it occurs and how strong it feels for each person. Generally, the more damaged the surface of your eye is, the greater the chance of experiencing burning with this medication.

FAQ 3: Can eye burning occur with other eye medications?

Yes, eye burning can occur with various eye medications, depending on the medication type, other ingredients in the formulation, and individual sensitivities. Also, individuals with a damaged ocular surface generally experience more irritation from eye drop use.

FAQ 4: How long does eye burning from topical cyclosporine typically last?

The duration of eye burning can vary. In most cases, it is temporary and lasts no more than 15 minutes. If the burning sensation persists, consult your healthcare provider.

FAQ 5: Will the burning from cyclosporine eye drops damage my eyes? 

Burning is a known side effect of the medication, but it improves as the eye surface heals over time with continued use.

Cyclosporine eye drops are a medicine, not an immediate soothing agent like artificial tears. It may take up to 6 months to see improvement in dry eyes because the medication works slowly, but it is very effective for treating dry eyes with long-term use.

FAQ 6: Are there any natural remedies to alleviate eye burning from cyclosporine eye drops?

Yes, as mentioned above, you can use artificial tears before putting in cyclosporine eye drops, chill the medication before use, and use cool compresses to help with eye burning from its use.

FAQ 7: What is the difference between Restasis and cyclosporine eye drops?

Restasis is a brand-name drug that contains cyclosporine as its active ingredient.

Cyclosporine is also available under other trade names.

FAQ 8: What are the different types of Restasis?

Restasis comes in multi-dose bottles and single-use vials. The single-use vials are preservative-free and may cause less eye irritation. However, they are also more expensive than the multi-dose formulation.

FAQ 9: Are Restasis and Cequa the same?

Cequa contains a higher dose of cyclosporine than Restasis. (0.09% vs. 0.05%)

Conclusion

Eye burning is a known side effect of cyclosporine eye drops, a medication used for treating various eye conditions, including dry eye disease.

Although it can be bothersome, eye burning is usually temporary and can be managed effectively.

Strategies like using lubricating eye drops, applying cool compresses, avoiding irritants, and adjusting and adding additional medication can help relieve the discomfort.

It’s important to consult healthcare providers for personalized guidance and explore alternative treatments if necessary.

With proper care and management, people can benefit from the use of cyclosporine eye drops while minimizing eye burning.

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