TACROLIMUS: A SAFE AND EFFECTIVE ALTERNATIVE FOR SEVERE VERNAL KERATOCONJUNCTIVITIS

The purpose of our work is to evaluate the long-term safety and efficacy of tacrolimus 0.1% ointment as an alternative for the treatment of severe or resistant vernal keratoconjunctivitis in a pediatric case.

The ophthalmology department of the military training hospital Mohammed V in Rabat, Morocco.

Vernal keratoconjunctivitis is a bilateral chronic conjunctival sight-threatening inflammation that usually affects young males under 10 years old. Ocular symptoms include itching, foreign body sensation, redness, tearing and photophobia which are usually responsible for repetitive school absenteeism. Ophthalmological examination finds a papillary response in the limbal and tarsal conjunctiva with a corneal involvement in severe forms.

We report the case of an eight-year-old boy followed up for vernal keratoconjunctivitis for four years. The patient was treated with olopatadine 0.1%, an antihistaminic and mast cell stabilizing eye drops along with topical steroids. He underwent an allergen immunotherapy. Besides treatment, the patient suffered from important itchiness, foreign body sensation, redness, tearing and bilateral ptosis which made it impossible for him to attend school. At the examination, we found tarsal and limbal papillae and diffuse punctuate epithelial keratitis more important in the left eye.

After analyzing the medical history of the kid, we concluded to have bilateral severe keratoconjunctivitis depending on a high dose of topical steroids. We decided to prescribe tacrolimus ointment 0.1% daily to avoid the side effects of long-term use of steroids. The patient was followed-up every month for six months, then every four months for one year.

The patient reported the disappearance of all ocular symptoms except for a mild sensation of itchiness after two months of treatment. On examination, visual acuity was 20/20 after three months of treatment. Reduction of the volume of tarsal papilla and disappearance of limbal papilla at two months was observed. The cornea was fluoresceine negative at three months. At follow-up, we didn't observe any recurrence of symptomatology nor any complications at 18 months follow-up. 

Vernal keratoconjunctivitis is a chronic conjunctival inflammation that occurs in male infants in the Mediterranean and African regions. It is sight-threatening and induces important school absenteeism. Tacrolimus is an effective and safe alternative that could be used in severe and resistant form to avoid the side effects of a long-term and high-dose regimen topical steroid treatment.