Topical Tacrolimus Ointment for Treatment of Intractable Atopic Keratoconjunctivitis: A Case Report and Review of the Literature

Abstract

Application of tacrolimus 0.03% dermatologic ointment into the lower fornix seems to constitute an interesting alternative treatment for atopic keratoconjunctivitis that is refractory to traditional treatment.

Sterile Corneal Infiltrates Secondary to Psoriasis Exacerbations: Topical Tacrolimus as an Alternative Treatment Option

“…15 Topical tacrolimus is becoming increasingly popular in dermatology for conditions such as atopic dermatitis and severe dermatitis lesions including cutaneous psoriasis, 17 whereas others have showed efficacious results in some ocular surface or corneal disorders. 18 Different preparations of tacrolimus ointment have been described. The 0.02% tacrolimus ointment used in these 2 patients was prepared as previously described.…”

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

“…Tacrolimus has a more potent immunosuppressant action, 15 and initial evidence indicates that it may be more effective for treating some ocular surface diseases with fewer side effects than cyclosporine A (burning sensation and pain on application). 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.…”

“…[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). The Protopic ointment contains either 0.03% or 0.1% of tacrolimus in a base of mineral oil, paraffin, propylene carbonate, white petrolatum, and white wax.…”

Atopic keratoconjunctivitis

“…These case reports reported no occurrence of severe adverse events. [91][92][93] Comparing tacrolimus 0.1% ointment to clobetasone butyrate 0.05% ointment in a doublemasked crossover AKC study (n ϭ 25) applied twice daily for 3 weeks, both treatments were effective in reducing signs and symptoms of eyelid eczema, but with tacrolimus showing superiority to clobetasone. 94 Low-dose systemic tacrolimus given for 1 year has also been shown in a retrospective study to be effective and safe in the treatment of severe AKC unresponsive to conventional therapy.…”