USAGE OF CICLOSPORIN EYE DROPS IN PEDIATRIC AGE: CASE REPORTS

To report the usage of ciclosporin eye drops 1 mg/ml in the pediatric population with the diagnosis of vernal keratoconjunctivitis (VKC) who showed a lack of disease control with other treatments.

VKC is a severe form of ocular allergic conjunctivitis affecting predominantly children.(1, 2) This pathology has a significant impact on their daily activities, often leading to a decrease on school performance. The main symptoms are eyes redness, ocular itching, discharge, tearing and photophobia; and clinically we can observe conjunctival hyperemia, conjunctival papillae, Horner-Trantas dots and keratitis.(1) Considering the disease’s impact, all efforts to improve the quality of life must be done. The usage of immunomodulatory agents such as topical ciclosporin is effective in the long-term treatment, since it is corticosteroid sparing in steroid-dependent patients when other treatments have failed.(3) In Portugal, the commercialized ciclosporin (Ikervis®) is only approved for administration in adults.(4) However, its off-label usage in the pediatric population has shown great benefits.

 

Case Report 1: A 6-year-old boy accompanied during the past 4 years due to VKC, very incapacitant, with intense itching and photophobia. He had also a history of atopic dermatitis and several bronchiolitis. When he presented to us in 2017, he had exuberant conjunctival papillae, conjunctival hyperemia and a superficial punctate keratitis with neovascularization. Since then, multiple cycles involving anti-inflammatory therapy, including corticosteroids, and ocular lubricants were performed, with a relapse every time corticosteroids were abandoned. Only in the being of 2021, when the ciclosporin was introduced, were he able to achieve partial remission and control of his disease.

Case Report 2: 7-year-old girl with a history of rhinitis, asthma and allergies, evaluated in 2018 for palpebral edema, eye redness and ocular itching. She had conjunctival hyperemia and papillae, blepharitis and Horner-Trantas dots. She was treated with tobramycin + dexamethasone and ketotifen with significant improvement. However, she came back about a year later complaining about recurrent eye redness and itching during this period. At this moment, besides the previous signs, she also had a superficial punctate keratitis. She was submitted to various cycles of treatment, which included corticosteroids, with relapse of the disease when they were stopped. Similarly to the previous case, there was only a sustained improvement when the ciclosporin was introduce, with total remission. They were both forwarded to a pediatrician specialized in allergies to study them systemically.

In pediatric patients presenting with corticosteroid dependent VKC the ciclosporin can be a helpful ally in the disease control, avoiding chronic usage of corticosteroids and providing a significant improvement of the clinical status and quality of life of these patients.(3)