Subconjunctival adalimumab for treatment of dry eye disease in Sjögren’s syndrome

Abstract

Objective: To describe the use of subconjuctival administration of the anti-tumor necrosis factor agentadalimumab for treatment of dry eye in patients with Sjögren’s syndrome, and to investigate conjunctivalhealing.Methods: Prospective, nonrandomized, noncomparative interventional case series including consecutivepatients with Sjögren’s syndrome and dry eye disease treated with subconjunctival adalimumab, whowere refractory to conventional treatment. Patients with infectious ocular surface involvement orstructural changes in the tear pathway or eyelids were excluded. Data recorded included age, sex,lissamine green staining pattern, Schirmer test results, intraocular pressure, conjunctival mobility,tear break up time and findings of biomicroscopic evaluation, following fluorescein dye instillation.The Ocular Surface Disease Index questionnaire validated for the Portuguese language was used forsubjective assessment of patients.Results: Eleven eyes of eight patients were studied. Mean patient age was 53±13.4 years. Patients weretreated with subconjunctival injection of 0.03 mL of adalimumab and followed for 90 days thereafter.There were no statistically significant objective improvement (objective tests results; p>0.05) and nostatistically significant changes in intraocular pressure (p=0.11). Questionnaire responses revealed asignificant improvement in ocular symptoms (p=0.002).Conclusion: Based on the Ocular Surface Disease Index questionnaire, subconjunctival administrationof adalimumab improved dry eye symptoms. However, objective assessments failed to reveal statisticallysignificant improvements.