A Retrospective Crossover Study on Cross-Linked Hyaluronic Acid Gel (Lacrifill) Versus Cyclosporine A 0.05% (Restasis) for Dry Eye Disease

Purpose: This retrospective crossover study compares two-month outcomes of cyclosporine A ophthalmic emulsion 0.05% (Restasis) versus cross-linked hyaluronic acid gel (Lacrifill), a novel canalicular occlusive device, in 20 patients with refractory aqueous-deficient dry eye disease (DED) at a rural optometry clinic. Methods: In patients with moderate to severe DED, two-month outcomes for Restasis and Lacrifill (after a washout period) were compared using tear breakup time (TBUT), Schirmer scores, corneal staining (Efron scale), and Ocular Surface Disease Index (OSDI) scores. Paired t-tests or Wilcoxon signed-rank tests were used (p<0.05), with strict adherence to ethical compliance. Results: Both treatments improved TBUT, Schirmer scores, corneal staining, and OSDI from baseline (p<0.001). Lacrifill outperformed Restasis: TBUT (+2.28 vs. +1.30 s, p<0.001), Schirmer (+2.33 vs. +1.08 mm, p=0.001), staining (-1.03 vs. -0.55 grade, p=0.003), and OSDI (-33.33 vs. -10.83 points, p<0.001). Eye-level analyses (N=40) confirmed these findings, with no age or sex associations (p>0.05). Conclusion: Lacrifill provided superior tear retention and symptom relief during the first two months of treatment compared to Restasis in refractory aqueous-deficient DED, supporting occlusion therapies in DED management. Larger prospective trials are needed to confirm efficacy and explore the use of combination therapies (typically three to six months).