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Published on: November 8, 2015
Syphilitic interstitial keratitis treated with topical tacrolimus
Jacob Martin1, Laura Kopplin2, Deborah Costakos1
1Medical College of Wisconsin, 925 N 87th St, Milwaukee, WI, 53226, USA.
Insights
Topical tacrolimus offers a new treatment for syphilitic interstitial keratitis in children. This approach is effective for patients experiencing steroid-induced high intraocular pressure, preventing disease recurrence.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Pediatrics
Background:
- Syphilitic interstitial keratitis (SIK) is an inflammatory eye condition often associated with congenital syphilis.
- Standard treatment involves topical steroids, which can lead to significant side effects like elevated intraocular pressure (IOP).
Observation:
- A pediatric patient with congenital syphilis presented with bilateral SIK.
- Initial management with topical steroids resulted in steroid-induced ocular hypertension and recurrent keratitis.
- Topical tacrolimus was administered following a recurrence in the right eye.
Findings:
- The patient achieved sustained remission of SIK with topical tacrolimus.
- Normal intraocular pressure was maintained throughout the treatment period.
- The patient remained recurrence-free for nearly three years.
Implications:
- Topical tacrolimus is a promising alternative for managing SIK, especially in pediatric cases.
- This treatment is particularly valuable for patients intolerant to steroids due to elevated IOP.
- Tacrolimus offers a steroid-sparing option for chronic or recurrent SIK.
Purpose:
To report a case of syphilitic interstitial keratitis successfully managed with topical tacrolimus after the development of steroid-induced intraocular pressure elevation in a pediatric patient.
Observations:
A 4-year-old female with a history of congenital syphilis that was reportedly treated after birth presented with bilateral conjunctival redness, tearing, and photosensitivity. Initial ophthalmic examination revealed corneal vascularization with diffuse haze of the right eye and circumferential vascularization with stromal infiltrates of the left eye. She was diagnosed with bilateral syphilitic interstitial keratitis and initially managed with topical steroids but developed steroid-induced elevation of her intraocular pressure. She experienced several recurrences of keratitis as steroids were tapered. After a recurrence in her right eye, she was treated with topical tacrolimus. Since then, she has remained recurrence-free for almost three years with normal intraocular pressure.
Conclusion And Importance:
Tacrolimus represents a novel alternative for the treatment of syphilitic interstitial keratitis, which is particularly useful in patients that develop elevated intraocular pressures in response to long-term treatment with steroid eye drops.
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