Background: Vernal keratoconjunctivitis (VKC) is a bilateral, recurrent, chronic conjunctival inflammatory disease with seasonal exacerbations. This study aimed to assess the efficacy and safety of tacrolimus 0.03% eye ointment in the management of chronic VKC. Methods: This was an open-label, prospective, non-randomized, comparative interventional study that enrolled 50 patients with chronic VKC, who were allocated to one of two groups. The first group was treated with tacrolimus 0.03% eye ointment twice daily for 2 months then once daily for 2 months, followed by once every other day for another 2 months. The control group was treated with standard anti-allergic drugs, topical fluorometholone 0.1% eye drops three times daily for 2 weeks and gradually tapered for another 2 weeks, with topical olopatadine 0.1% administered twice daily during the follow-up period. Disease severity was assessed using a four-point scale for symptoms and signs. Treatment efficacy was assessed by analyzing changes in symptoms and signs, and by clinical photography. Results: Fifty patients with bilateral chronic VKC completed the follow-up. The mean (standard deviation) ages of the tacrolimus and control groups were comparable (16.20 [5.10] years versus 16.48 [4.19] years, P > 0.05). The most commonly reported symptom was itching, and the most common signs were papillary hypertrophy and conjunctival hyperemia. All symptoms and signs were significantly reduced after treatment in both groups. The tacrolimus group showed a more significant improvement at 3 and 6 months in the mean composite symptom score (both P < 0.05) and in the mean composite sign score (both P < 0.05). Regarding complications, one case of increased intraocular pressure occurred in the control group (4%) after 2 weeks of steroid treatment, while there were no complications in the tacrolimus group, except for some reports of stinging sensation, which was well tolerated. Conclusions: Treatment of chronic bilateral VKC with tacrolimus 0.03% eye ointment is effective and safe. It could be considered an alternative treatment to reduce steroid-associated complications in patients with chronic VKC. Future double-blinded clinical trials with a longer follow-up period are necessary to confirm our findings and to determine the long-term safety of topical tacrolimus 0.03% ointment in VKC.

Background: Vernal keratoconjunctivitis (VKC), a chronic bilateral eye disease, is a severe form of allergic conjunctivitis. Anterior-segment optical coherence tomography (AS-OCT) is a rapid, noninvasive, in vivo visualization modality for the anterior segment structures that has been used in diagnosing and staging diseases and assessing the treatment efficacy. We used anterior-segment optical coherence tomography (AS-OCT) to monitor the efficacy of the tacrolimus eye ointment in managing VKC. Methods: In this prospective follow-up study, we included patients with active symptomatic VKC. All patients were treated with the 0.03% tacrolimus ophthalmic ointment twice daily for 2 months and then once daily for 1 month. All patients underwent AS-OCT before and 3 months after treatment as an objective method to assess the treatment efficacy. Results: We included 20 eyes of ten patients (nine men and one woman) with active symptomatic VKC. The mean age was 17.3 (range: 11 – 36) years, with nine patients having a palpebral type and one patient having a mixed type of VKC. Substantial flattening and reduction in the papilla size were observed in all patients at the post-treatment follow-up. AS-OCT measurements revealed significant reductions in the vertical, horizontal, and total diameters of the palpebral papillae and limbal conjunctival thickness after 3 months of treatment compared to baseline measurements (all P < 0.001). No serious adverse effects attributable to tacrolimus administration were observed in the study period. Conclusions: AS-OCT is a suitable objective method for evaluating the treatment efficacy of the 0.03% tacrolimus eye ointment in patients with VKC. Future large-scale studies including a wide range of age groups with longer follow-up periods and AS-OCT monitoring at multiple post-treatment visits are required to confirm our preliminary results. Moreover, the diagnostic accuracy of AS-OCT in monitoring patients with active VKC should be tested in comparison with objective scoring by an experienced corneal fellowship.

This study aimed to evaluate the efficacy and safety of tacrolimus eye ointment compared to the standard anti allergic drugs for the management of chronic vernal keratoconjunctivitis (VKC).Methods: This was a prospective, nonrandomized comparative interventional study that enrolled 50 chronic VKC cases, which were assigned into 2 groups. The first group was treated with 0.03% tacrolimus eye ointment twice daily for 2 months then once daily for 2 months followed by once every other day for another 2 months. The second group was treated with standard anti allergic drugs, topical fluorometholone 0.1% eye drops 3 times daily for 2 weeks and gradually withdrawn for another 2 weeks plus topical olopatadine 0.1% twice daily during the follow up period. The severity of VKC was assessed by a four-point scale of symptoms and signs. The treatment efficacy was assessed by the analysis of changes in symptoms and signs.Results: Itching was the most common symptom reported and the most observed signs were conjunctival hyperemia and papillary hypertrophy. In both groups, there was a significant improvement in all symptoms and signs after treatment. The tacrolimus group showed a more significant improvement at 3 and 6 months in the mean composite symptom and sign scores. Regarding the complications, there was one case of increased IOP reported in the second group after 2 weeks of steroid treatment while there were no complications in the tacrolimus group only stinging sensation was reported in some cases and well tolerated.Conclusions: Tacrolimus 0.03%eye ointment was effective and safe and can be used as an alternative to reduce steroid-associated complications.

Background: Cycloplegic refraction is an essential part of the pediatric ophthalmic assessment and is the cornerstone of strabismus evaluation. This narrative review aimed to ascertain the current scope of practice for cycloplegic refraction in the pediatric population. Methods: An extensive literature review was conducted using ScienceDirect, PubMed/MEDLINE, Scopus, and Google Scholar databases using the following search terms: cyclopentolate, tropicamide, pediatric cycloplegia, atropine, homatropine, manual retinoscope, handheld autorefractometer, spherical errors, and no spherical errors of refraction in articles published from January 2000 to December 2022. Relevant retrieved references and practical points concerning pediatric cycloplegic refraction were summarized. Results: Atropine has the most potent cycloplegic effect and is best used in cases of severe accommodative esotropia. Because of the unfavorable side effects and risks associated with atropine, cyclopentolate has been found to provide quite effective cycloplegia, even for moderate to severe hyperopia, and has become the standard agent for traditional pediatric cycloplegic exams. Tropicamide has also been shown to provide adequate cycloplegia while being less toxic and causing fewer side effects. Tropicamide has the fewest side effects and toxicity of all agents, while atropine has the most. Cyclopentolate is an exceptionally safe cycloplegic agent. To detect spherical and non-spherical refractive errors, refraction can be performed using a handheld autorefractometer or a manual retinoscope, as well as under general anesthesia in some cases. The optimal time to wear eyeglasses to maintain binocular vision and avoid amblyopia is also considered. Conclusions: Accommodative power in children is at its maximum, and this interferes with reliable - assessment of refraction. Therefore, the use of cycloplegic refraction is mandatory during childhood to obtain actual refraction, which is considered the cornerstone for eyeglass prescription. Knowledge of the various cycloplegic agents used in childhood refraction is important for ophthalmologists and optometrists to obtain safe and effective cycloplegia. High refractive errors, as well as the presence of anisometropia or squint, necessitate the use of eyeglasses as early as childhood to maintain binocularity and depth perception.