ESCRS - FP26.10 - Impact Of Topical Cyclosporine A 0.05% On Ocular Surface Microbiota And Clinical Parameters In Patients With Sjögren’S Syndrome With Moderate-To-Severe Dry Eye

Impact Of Topical Cyclosporine A 0.05% On Ocular Surface Microbiota And Clinical Parameters In Patients With Sjögren’S Syndrome With Moderate-To-Severe Dry Eye

Published 2026 - 44th Congress of the ESCRS

Reference: FP26.10 | Type: Free paper | DOI: 10.82333/vqd7-8y11

Authors: Dr Rabianur Eroglu* 1 , Dr Berkay Yekta Ekren 2 , Dr Ali Arslan 3 , Dr Gamze Ozkan 1 , Prof. Dr Osman Ugur Sezerman 2 , Prof. Dr Semra Akkaya Turhan 4

1Ophthalmology,Marmara University,İstanbul,Türkiye, 2Biostatistics and Bioinformatics,Acıbadem MAA University,İstanbul,Türkiye, 3Molecular Biology and Genetics, Graduate School of Science & Engineering,Yildiz Technical University,İstanbul,Türkiye, 4Ophthalmology,Acıbadem MAA University,İstanbul,Türkiye

Purpose

To evaluate the ocular surface microbiota in patients with primary Sjögren’s syndrome (SS)-associated dry eye disease (DED) and to investigate the potential effects of topical 0.05% cyclosporine A (CsA) on clinical findings and the ocular microbiota.

Setting

Department of Ophthalmology, Marmara University Faculty of Medicine, Istanbul, Türkiye.

Methods

This prospective study included 50 eyes of 50 patients (25 early-stage and 25 moderate-to-severe SS-DED). The early-stage group received artificial tears (0.15% sodium hyaluronate), while the moderate-to-severe group received artificial tears plus 0.05% CsA. Conjunctival swabs were obtained at baseline and 6 months. DNA was extracted with the ZymoBIOMICS™ DNA Miniprep Kit, and ocular microbiota was profiled by full-length 16S rRNA sequencing on the Oxford Nanopore MinION. Phylum and genus level relative abundances and alpha/beta diversity were compared within and between groups. Clinical outcomes (DEQ-5, Schirmer I, Oxford staining, TBUT and non-invasive TBUT) were assessed at baseline and 6 months. 

Results

DEQ-5 was higher in moderate-to-severe SS-DED and decreased post-treatment (p<0.05). Schirmer,TBUT and non-invasive TBUT were lower in moderate-to-severe SS-DED (p<0.05); Schirmer was unchanged, TBUT increased only in this group (p<0.05), while non-invasive TBUT decreased in both groups (p<0.05). Bacillota and Pseudomonadota were dominant pre/post-treatment. Actinomycetota appeared post-treatment only in early SS-DED (p=0.015). In early SS-DED, the Observed index decreased at phylum and genus levels (p<0.05). Streptococcus increased in both groups (p<0.05), with genus-level beta diversity differed (p<0.05). LDA identified Gluconacetobacter,Snodgrassella and Bacillus as post-treatment discriminators in the moderate-to-severe group (log10>2)

Conclusions

CsA therapy significantly improved symptom scores and tear film stability in primary SS-associated DED. Post-treatment increases in Streptococcus and Bacillus, the emergence of Actinomycetota, and genus-level shifts in beta diversity indicate microbiota restructuring. This pattern may reflect suppression of pathogenic taxa with relative enrichment of commensals, contributing to reduced ocular surface inflammation and clinical improvement. The concordance between microbiota shifts and functional tear film outcomes supports a potential immunomodulatory effect of CsA on the ocular surface ecosystem.