Tear Flow in Cyclosporine Recipients

Abstract

To measure tear flow in renal allograft recipients who received oral cyclosporine as immunosuppressive therapy. Control subjects were from the staff of various clinics, dialysis patients were recruited, and one group of kidney transplant recipients took oral cyclosporine, whereas another group took azathioprine. Written informed consent was obtained for an institutionally approved protocol. A 4-minute Schirmer test with topical anesthetic was performed in both eyes of each person, and the average score was used in calculations. The tear flow rate was 10.6 mm/4 minutes in the control subjects, 13.6 mm/4 minutes in the dialysis patients, 10.4 mm/4 minutes in kidney transplant recipients taking azathioprine, and 19.0 mm/4 minutes in kidney transplant recipients taking cyclosporine. Kidney transplant recipients taking cyclosporine had significantly increased tear flow compared with the other three groups (P < 0.05); dialysis patients, kidney transplant recipients taking azathioprine, and control subjects showed statistically indistinguishable tear flow. Within-group comparisons (male versus female, black versus white, and all combinations) showed no statistically significant differences. Medications used by dialysis patients or the azathioprine group did not significantly increase tear flow compared with control subjects. The addition of cyclosporine (plus prednisone) enhanced tear flow in kidney transplant recipients compared with all other groups. Systemic cyclosporine appears to increase tear flow even when no lacrimal autoimmune disease exists.