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Topical tacrolimus 0.03% monotherapy for vernal keratoconjunctivitis—case series
  1. P M K Tam,
  2. A L Young,
  3. L L Cheng,
  4. P T H Lam
  1. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
  1. Correspondence to Alvin L. Young, Cornea and External Eye Disease, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China; youngla{at}ha.org.hk

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Ophthalmic manifestations of vernal keratoconjunctivitis (VKC) may be divided into actual allergic responses (giant papillae, Trantas dots) and sequelae of chronic inflammation (tarsal cicatrisation, corneal vascularisation). Mast cell-targeted therapy and anti-histamines are useful in alleviating symptoms from early pathogenic steps,1 but once T-cell-mediated reactions enter stage, these may become insufficient. A vicious cycle develops when chronic ocular surface inflammation results in tarsal scarring, secondary dry eyes and eyelid malposition. Topical steroid is indicated for severe exacerbations, but its long-term use is associated with complications such as cataract and glaucoma. Topical cyclosporine is the only commercially available in 0.05% and is indicated for aqueous deficient dry eyes. However, a previous report has shown that vernal ulcers would not respond to concentrations <1%.2

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