On the other hand, Dr. Sheppard reports successful outcomes when using cyclosporine in patients with dry eye who have pure aqueous tear deficiency. For patients with dry eye accompanied by redness, blepharitis, significant tarsal changes, or ocular allergy, he administers induction therapy with a topical steroid at one visit and then maintains them on cyclosporine for the long term. Once the patients are in a successful maintenance phase, Dr. Sheppard recommends that they use their steroid for acute flare-ups triggered by travel, allergies, respiratory infection, or exposure to environmental irritants. His steroid of choice for this indication is loteprednol.
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