Refractory Pediatric Vernal Keratoconjunctivitis Successfully Controlled With Combined Topical Immunomodulation And Systemic Omalizumab Therapy
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR459 | Type: Poster | DOI: 10.82333/t13c-yj79
Authors: Dr Marta García Díaz* 1 , Dr Nora Besteiro Suárez 1 , Dr María de los Ángeles Leal González 1 , Dr Oier Pérez Díaz 1 , Dr María Platero Vázquez 1 , Dr María Mercedes Cabezas León 1 , Dr Laura Alonso Martín 1
1Ophthalmology,Complejo Hospitalario Universitario de Toledo,Toledo,Spain
Purpose
To describe the therapeutic challenge of severe pediatric vernal keratoconjunctivitis (VKC) refractory to conventional therapy and to report long-term control achieved through stepwise escalation to combined topical immunomodulation and systemic biologic therapy.
Setting
Single tertiary referral center for ocular surface disease.
Methods
A 7-year-old boy with asthma presented with bilateral redness, itching, and discomfort for 15 days. Skin prick tests were negative. Slit-lamp examination revealed limbitis, Trantas nodules, giant tarsal papillae, and inferior superficial punctate keratitis (SPK).
Previous treatment with topical antihistamines and corticosteroids led to steroid-dependent disease. Environmental measures and lubricants were added. Due to insufficient control, topical ciclosporin A 1–2% was introduced without successful tapering. Ten months after onset, subcutaneous omalizumab 300 mg every 15 days was initiated. Persistent seasonal exacerbations prompted addition of topical tacrolimus 0.03% and reduction of ciclosporin A to 0.1%.
Results
Following combined therapy with omalizumab, topical tacrolimus, and low-dose ciclosporin A, the patient reported marked symptomatic improvement with complete resolution of itching and discomfort.
Objective findings showed absence of conjunctival hyperemia, limbitis, Trantas nodules, corneal involvement, or SPK. Only residual micropapillae persisted on the tarsal conjunctiva. The crystalline lens remained clear.
Topical corticosteroids were successfully discontinued after gradual tapering. At last follow-up, disease control was maintained with omalizumab 300 mg every 21 days, ciclosporin A 0.1% once daily, tacrolimus 0.03% once daily, azelastine twice daily, lubricants as needed, and environmental measures.
Conclusions
Severe pediatric VKC may become corticosteroid-dependent and refractory to standard topical therapy. Stepwise escalation combining topical immunomodulators and systemic biologic therapy can achieve sustained disease control and allow safe corticosteroid withdrawal.
Early multidisciplinary management and individualized therapeutic combinations may prevent long-term ocular surface damage in challenging pediatric VKC cases.