Topical Tacrolimus Ointment for Treatment of Refractory Anterior Segment Inflammatory Disorders

Abstract

Tacrolimus ointment appears to be an effective alternative for certain ocular inflammatory conditions refractory to traditional treatments. There may be an increased risk of herpes simplex virus keratitis associated with topical use. Our results support previous literature of patients benefiting from topical tacrolimus use.

Effect of Topical Tacrolimus in the Treatment of Thygeson's Superficial Punctate Keratitis

“…16 Tacrolimus generally is an effective alternative for specific ocular inflammatory conditions refractory to traditional treatments such as dry eye, 17 ocular surface inflammation in patients with graft versus host disease, 18,19 allergic 10,16,[20][21][22][23][24][25][26][27][28][29] lens-induced papillary conjunctivitis, 30 corneal subepithelial infiltrates secondary to adenoviral keratoconjunctivitis, 31 superior limbic keratoconjunctivitis, 32 refractory phlyctenular keratoconjunctivitis, 33 ocular cicatricial pemphigoid, 34,35 and anterior segment inflammatory disorders. [5][6][7]9 In addition, patients who are intolerant of cyclosporine can be treated effectively with topical tacrolimus. 18 The commercially available tacrolimus ointment is a dermatologic formulation (Protopic, tacrolimus ointment 0.03% and 0.1%, Protopic, Astellas Pharma Tech Co., Toyama, Japan) and has been used to treat atopic eczema and ocular surface diseases without side effects or patient intolerance 9,10,19,21,23,24,26,[32][33][34] (Table 2).…”

Long-term Result of Maintenance Treatment With Tacrolimus Ointment in Chronic Ocular Graft-Versus-Host Disease

“…7 However, long-term steroid use can cause complications such as glaucoma, cataract, and secondary infection. 8 In this study, IOP increased in 46.2% of the eyes treated with steroids, necessitating an alternative treatment.…”

“…32-34 Short-term, low-frequency application of steroids and long-term use of topical cyclosporine eye drops have been recommended as treatment for chronic ocular GVHD. 29 Because tacrolimus has a mechanism of action and pharmacokinetics similar to cyclosporine but much higher potency, 8,9 tacrolimus ointment would be expected to be a more effective maintenance treatment for chronic ocular GVHD, especially in patients with ocular surface inflammation.…”

“…9,10 A number of studies have described the effects of topical tacrolimus for treating various immune-mediated ocular diseases. 8,11,12 We recently reported that 0.02% tacrolimus ointment was an effective treatment in patients with refractory ocular surface inflammatory diseases, including StevensJohnson syndrome, ocular cicatricial pemphigoid, scleritis, and Mooren ulcer, who had previously received topical steroid treatment. 11 This ointment has also been used in the organ-specific treatment of skin and oral GVHD.…”

“…7 However, long-term steroid use can cause undesirable side effects, including steroid-induced intraocular pressure (IOP) elevation, cataract, and superinfection. 8 It is therefore necessary to develop alternative treatments that have more potent anti-inflammatory actions with fewer side effects than steroids.…”