Efficacy and safety of topical cyclosporine 0.1% in moderate-to-severe dry eye disease refractory to topical cyclosporine 0.05% regimen.

CsA has a neurotrophic effect either by directly acting on nerve cells[ 31 ] or by inducing the epithelial cell to secret nerve growth factor.[ 32 ] Furthermore, as the primary mode of action, CsA breaks the vicious cycle of dry eye by reducing inflammation and may re establish a healthy environment for nerve regeneration.[ 33 ] Improvement failed to reach statistical significance in Schirmer's test and OSDI score.

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