Systemic tacrolimus in the treatment of severe atopic keratoconjunctivitis

Severe atopic keratoconjunctivitis (AKC) forms part of the spectrum of allergic eye disease and is often refractory to conventional topical treatment. Topical cyclosporin A and tacrolimus have been shown to reduce immunologic activation, symptoms, and signs of patients suffering from AKC, but there are no reports on safety and efficacy of systemic tacrolimus for this condition.

We report on a retrospective study of 3 patients with severe AKC, where the disease did not respond to conventional therapy, and they were therefore treated with low-dose systemic tacrolimus for at least 1 year as an adjunct to their existing treatment.

There was a good clinical response in all patients to low-dose systemic tacrolimus, with a low incidence of side effects and no relapse of symptoms after discontinuation of treatment.

Low-dose systemic tacrolimus is a safe and effective treatment of some patients with severe AKC, which is refractory to conventional treatment. Such patients need careful monitoring for side effects, and the long-term benefits need to be assessed as part of a clinical trial.