Immunomodulatory (Calcineurin Inhibitor) — Dry Eye Disease Pregnancy: Not recommended in women of childbearing potential not using effective contraception; no data in pregnant women — not recommended during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus. Breast-feeding: decision to discontinue breast-feeding or therapy taking benefits into account (§4.6)

Ciclosporin 0.1% Eye Emulsion

Brand names: Ikervis, Verkazia

Ciclosporin 0.1% eye emulsion is a topical immunomodulator (calcineurin inhibitor) used to treat severe keratitis in adults with dry eye disease that has not improved with tear substitutes.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One drop to the affected eye(s)

Route: Ocular use (topical eye drops, emulsion, single-dose container)

Frequency: Once daily at bedtime

Max: Patients should be advised not to instil more than one drop in the affected eye(s) (§4.2)

Source SPC is IKERVIS 1 mg/mL eye drops, emulsion (ciclosporin). §4.2: 'The recommended dose is one drop once daily to be applied to the affected eye(s) at bedtime.' Treatment must be initiated by an ophthalmologist or a healthcare professional qualified in ophthalmology. Response to treatment should be reassessed at least every 6 months. If a dose is missed, continue treatment on the next day as normal. Elderly: no dose adjustment required. Administration: wash hands; gently shake the single-dose container before use; single use only — each container is sufficient to treat both eyes and any unused emulsion should be discarded immediately; use nasolacrimal occlusion and close the eyelids for 2 minutes after instillation to reduce systemic absorption. If more than one topical ophthalmic product is used, administer at least 15 minutes apart with IKERVIS last. Paediatric (§4.2): 'There is no relevant use of ciclosporin in children and adolescents aged below 18 in the treatment of severe keratitis in patients with dry eye disease, which has not improved despite treatment with tear substitutes.' Remove contact lenses before instillation at bedtime; may be reinserted at wake-up time.

Dose adjustments

Renal

The effect of ciclosporin has not been studied in patients with hepatic or renal impairment; however, no special considerations are needed in these populations (§4.2)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Ocular or peri-ocular malignancies or premalignant conditions
Active or suspected ocular or peri-ocular infection

Side effects

Very common: eye pain (19.0%)
Very common: eye irritation (17.5%)
Common: ocular hyperaemia (5.5%)
Common: lacrimation increased (4.9%)
Common: erythema of eyelid (1.7%), vision blurred, eyelid oedema, conjunctival hyperaemia, eye pruritus
Uncommon: bacterial keratitis, herpes zoster ophthalmic, instillation site reaction, headache

Interactions

No interaction studies have been performed (§4.5)
Corticosteroid eye drops — co-administration could potentiate the effects of ciclosporin on the immune system (§4.5)
Beta-blockers (known to decrease tear secretion) — regular clinical monitoring when treating concomitantly (§4.4)
Other topical ophthalmic medicinal products must be administered at least 15 minutes apart, with this product last (§4.2)

Clinical monograph

How it works

Ciclosporin inhibits calcineurin in T-lymphocytes, dampening the ocular surface inflammation that drives dry eye-associated keratitis and helping restore tear production.

Prescribing in practice

Contraindicated in active or suspected ocular or periocular infection, as immunomodulation may exacerbate it.
Instillation site reactions such as eye pain, stinging and irritation are common, particularly early in treatment.
Therapeutic benefit develops gradually over weeks, so it should be continued rather than judged on immediate effect.

Monitoring

Periodically review the ocular surface and treatment response, and remain alert for ocular infection during prolonged immunomodulatory therapy.

Counselling the patient

Some stinging or burning on instillation is common and usually settles with continued use.
Remove soft contact lenses before instilling and wait before reinserting them.
Benefit builds up over several weeks, so keep using it as prescribed even if there is no immediate change.

Evidence & guidelines

Topical ciclosporin is recommended for severe dry eye keratitis that is refractory to ocular lubricants, in line with current ophthalmology practice.

Reference: NICE TA369 (Ikervis for Dry Eye Disease, 2015); SPC Ikervis; SPC Verkazia; TFOS DEWS II Report (Ocul Surf 2017); Confirm identity and dosing against the manufacturer SPC (eMC) and NICE. Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways