Combined therapy for vernal shield ulcer

A 22-year-old male patient presented with complaints of pain and redness in the right eye. Slitlamp examination revealed giant papillae on both tarsal conjunctivae, bilateral punctate corneal epitheliopathy and a 2.9 x 2.9 mm epithelial defect in the right eye. The diagnosis was bilateral vernal keratoconjunctivitis with shield ulcer in the right eye. Treatment was commenced with prednisolone (1%) eye drops four times daily and sodium hyaluronate (0.1%) eye drops eight times daily. After one week, the patient had improved symptomatically but the epithelial defect remained unchanged. Topical cyclosporine (0.05%) applied eight times per day was added to the regimen of topical corticosteroid and artificial tears. Three weeks after commencing combined therapy, the shield ulcer had healed completely, leaving a corneal opacity that negatively stained with fluorescein. The patient was followed for five months and no recurrence of ulcer was noted, despite the discontinuation of topical cyclosporine and prednisolone. Simultaneous institution of topical corticosteroid, artificial tears and topical cyclosporine seems to augment the therapeutic efficacy of each other and may be a promising regime in the management of shield ulcer.