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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
Tacrolimus is more …
Competing interests None.
Provenance and peer review Not commissioned; not externally peer reviewed.