An observational comparative study of 33 migraine sufferers who were referred from a neurology clinic and 33 control subjects who were referred from an ophthalmology outpatient clinic found that an increased frequency of dry-eye disease might be related to migraine headaches. The control subjects had neither systemic nor ocular disease nor any type of headache. All 66 patients underwent a complete ophthalmic examination and diagnostic tests for dry eye, including tear breakup time, Schirmer test with topical anesthesia, lissamine green staining and an ocular surface disease score. Patients with migraine were classified as migraine with aura (n=17, 53 percent), migraine without aura (n=11, 33 percent) and basilar migraine (n=5, 15 percent); a pain score from one to four was determined for each patient based on the American Headache Society’s Migraine Disability Assessment Test.

Significant differences in dry eye scores were found between the patients with migraine and the control subjects. In the migraine group, the mean tear breakup time was 7.75 ±2.37 seconds, whereas in the control group it was 9.15 ±1.93 seconds. For the Schirmer test, the migraine group had a mean value of 12.09 ±4.95 mm/5 minutes, whereas the control group had a mean value of 14.90 ±4.26 mm/5 minutes. Testing with lissamine green staining resulted in a mean value of 1.00 ±0.16 in the migraine group and 0.30 ±0.46 in the control group. In the migraine group, the mean for the ocular surface disease index scoring was 36.27 ±17.54. In the control group, it was 28.42 ±9.0. A significant difference (p<0.05) was found in the dry-eye syndrome testing results between the two groups in the study.

Researchers from Bangkok ran a three-month, randomized and double-masked clinical trial comparing the efficacy of topical cyclosporine [0.05% cyclosporine A (CsA)] and preservative-free artificial tears in the treatment of meibomian gland dysfunction, concluding that topical CsA 0.05% twice daily may help treat MGD by improving tear-film stability.

Patients (n=70) with symptomatic MGD and unstable tear film (tear-film breakup time <8 seconds) were randomized to a topical CsA (0.05%, group A) and 0.5% carboxymethylcellulose (control, group B) instilled twice daily for three months. Ocular Surface Disease Index (OSDI); lid margin inflammation; meibomian gland expression; conjunctival injection; corneal and interpalpebral dye staining; and noninvasive tear breakup time (NIBUT) using the Tearscope Plus and invasive fluorescein tear breakup time (FBUT) and Schirmer I test were performed.

At the three-month evaluation, mean OSDI, NIBUT and FBUT; lid margin inflammation; meibomian gland expressibility; and tarsal injection showed significant improvement from baseline in group A (p<0.01, p<0.01, p<0.001 and p<0.001). In group B, only the OSDI improved significantly from baseline at three months (p=0.003). TBTs (NIBUT and FBUT) were significantly longer in group A at all visits, and the mean change of TBUTs was also significantly greater in group A at three months (p<0.001).