Tacrolimus safe, effective for severe allergic conjunctivitis

This prospective study found that tacrolimus eye drops are highly effective at treating refractory allergic conjunctivitis with proliferative lesions, and may reduce or replace topical steroid use.

Subjects included 1,436 patients with refractory and severe allergic conjunctivitis with proliferative lesions and/or corneal involvement that responded poorly to conventional antiallergic agents, such as ophthalmic solutions, topical steroids and/or cyclosporine.

All patients received one drop of tacrolimus ophthalmic suspension 0.1% administered twice daily. Concomitant use of steroids was allowed at the discretion of the attending physician.

After one month of treatment, clinical signs and symptoms of allergic conjunctivitis were greatly reduced. The drug proved effective in patients whose condition did not respond well to topical cyclosporine therapy. Approximately half of the patients were successfully weaned, and side effects were minimal, with transient burning the most common.

They note that corneal infection occurred in five patients (herpetic keratitis, two cases; bacterial keratitis, two cases; bacterial corneal ulcer, one case), for a total incidence of 0.35%. This suggests that close monitoring is necessary during prolonged use of topical tacrolimus.

Discussion question: How can you incorporate this treatment into your practice?