Use of tacrolimus ointment (0.03%) for refractory VKC

We report a series of 8 children with severe vernal keratoconjunctivitis who presented to us over last two years. The mean age was 7.375 years. The mean vision was 0.375 OD and 0.3625 OS. All these children were using topical steroids of varying strengths for more than two year. 2 out of 8 children had secondary glaucoma. The mean intraocular pressure was 21.75 + 4.74 OD and 23.25 + 6.25 mm of Hg OS. The highest IOP recorded was 28 mm Hg. All patients with glaucoma had early optic disc changes. Topical steroids were stopped for all patients and they were started on topical tacrolimus eye ointment (0.03%) twice a day along with lubricants. Patients relative were counseled to avoid eye rubbing, ignore minimal redness of eyes and counseled against any form of steroids. All patients continued tacrolimus for 3 months. Tacrolimus ointment was stopped at 3 month and lubricants were continued. Follow up was done at 1st week, 3rd week, 6th week, 3rd month and monthly thereafter till 6 months. At 6 months follow up all except one patient was discontinued of antiglaucoma medication.