Efficacy of Topical Cyclosporine Versus Topical Diquafosol in Treating Dry Eye Disease: A Systematic Review and Meta-Analysis

Abstract

Purpose:

This study compared the clinical efficacy of cyclosporine A (CsA) and diquafosol (DQS) in improving outcomes for patients with dry eye disease (DED).

Methods:

We systematically searched PubMed, Embase, Cochrane Library, and Web of Science for studies published before July 13, 2025. Eligible studies included randomized controlled trials (RCTs) and non-RCTs comparing the clinical efficacy of CsA and DQS in treating DED. The primary outcomes were changes in subjective and objective ocular examination results for DED. A random-effects model was used for meta-analysis.

Results:

We included nine studies in the systematic review and finally included six studies (three RCTs and three non-RCTs) in the meta-analysis. These studies analyzed 724 patients, with 367 receiving CsA and 357 receiving DQS. Pooled results revealed no significant differences in improvement of corneal staining scores, conjunctival staining scores, and tear break-up time between the two treatment groups. Subgroup analyses stratified by 1- and 3-month follow-up periods yielded consistent results. However, CsA treatment demonstrated a borderline significant improvement in the Schirmer test (P = 0.046) compared with DQS, whereas DQS treatment yielded greater improvement in the Ocular Surface Disease Index compared with CsA (mean difference = 3.413; 95% CI = 0.700–6.126; P = 0.014).

Conclusion:

This study revealed that CsA and DQS did not differ significantly in their efficacy in improving most objective clinical indices for DED over 1–3 months of treatment. However, DQS demonstrated greater improvement in subjective patient-reported outcomes. Future RCTs should explore the long-term efficacy of these treatments.