Topical tacrolimus treatment of atopic eyelid disease

Rikkers, Sarah M; Holland, Gary N.; Drayton, Gail E; Michel, Franz K; Torres, Mark F.; Takahashi, Stefani

doi:10.1016/s0002-9394(02)01982-7

Cited by 102 publications

(48 citation statements)

References 11 publications

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“…Previously, systemic tacrolimus in the form of oral preparation has successfully been used in refractory severe AKC. 25,26 Furthermore, to treat allergic disease, some studies have used either a commercially available 0.03-0.1% 'skin' ointment applied to eyelids 17,18,20,27 or fornix, 21 or they have used their own-made 0.02-0.1% ointment for the eye. 22,23 Because it is more convenient to use an eye drop rather than an ointment, Sengoku et al 28 used 0.01-1% eye drop in an animal study of ocular allergy and Ohashi et al 24 used an 0.1% ophthalmic suspension for a clinical study.…”

Section: Discussionmentioning

confidence: 99%

“…In ophthalmology, tacrolimus has mainly been used to suppress immune reactions in corneal and limbal transplantations, [8][9][10][11][12] uveitis, [13][14][15] and allergic eye disease. [16][17][18] However, there is no commercially available ophthalmic preparation for tacrolimus.…”

Section: Introductionmentioning

confidence: 99%

“…Topical tacrolimus with concentrations of 0.02-0.1% in ointment form has successfully been used for treatment of atopic keratoconjunctivitis (AKC), [18][19][20] giant papillary conjunctivitis, 21 and VKC. 22,23 In a recent study, 0.1% ophthalmic suspension of tacrolimus has been used for treatment of AKC and VKC with only 4 weeks of follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Kheirkhah

Zavareh

Farzbod

et al. 2011

Eye

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Purpose To evaluate the efficacy and safety of topical 0.005% tacrolimus eye drop for treatment of refractory vernal keratoconjunctivitis (VKC). Methods This prospective study included 20 eyes of 10 patients with refractory VKC, who had active symptomatic disease despite conventional medications including topical steroids. After discontinuing all other medications, patients were treated with topical 0.005% tacrolimus eye drop four times a day. Changes in subjective symptoms and objective signs after treatment were evaluated, and development of possible complications was assessed. Results Mean age of patients was 21.3±7.4 years and mean duration of VKC was 12.1±5.8 years. After starting tacrolimus eye drop, patients were followed for a mean duration of 10.7 ± 3.7 months (range, 6-15 months). All symptoms including itching, redness, photosensitivity, foreign body sensation, and mucus discharge improved after the treatment; itching was the first symptom to show dramatic relief. In addition, there was improvement in objective signs including conjunctival hyperaemia, conjunctival papillary hypertrophy, giant papillae, limbal hypertrophy, corneal punctate epithelial erosions, and corneal pannus; conjunctival hyperaemia was the first sign to show improvement. No patient required addition of other medications including steroids for further relief. Any attempt to discontinue tacrolimus eye drop was associated with recurrence of patients' symptoms and signs, necessitating continued use of the medication during the entire follow-up time. No ocular complication related to tacrolimus was noted. Conclusion Topical 0.005% tacrolimus eye drop seemed to be a safe and effective treatment for steroid-resistant refractory VKC; however, long-term use was needed to control the disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Kheirkhah

Zavareh

Farzbod

et al. 2011

Eye

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“…28,29 A positive effect of extended eyelid treatment with tacrolimus has also been reported on conjunctivitis and keratitis. 13,16,20 Hence, we wanted to know whether a reduction of ocular surface inflammation could be produced by regional eczema treatment. Moreover, there seems to be a positive relationship between conjunctival disease and inflammatory cells as well as cytokines in tear fluid, 18 which was the reason why these objective measures were included in our protocol.…”

Section: Discussionmentioning

confidence: 99%

“…9 As an alternative to steroids, tacrolimus ointment is a valid therapeutic option for atopic dermatitis since more than 5 years. [10][11][12] Successful treatment of eyelid eczema in AKC patients has further been documented in case series 7,13 and three noncontrolled open-label studies. [14][15][16] To the best of our knowledge, no comparative trial of tacrolimus ointment and steroid ointment for eyelid dermatitis has been performed.…”

Section: Introductionmentioning

confidence: 99%

Tacrolimus ointment vs steroid ointment for eyelid dermatitis in patients with atopic keratoconjunctivitis

Nivenius

Ploeg

Jung³

et al. 2006

Eye

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Aims The main objective of this explorative study was to evaluate if tacrolimus ointment could be safer than corticosteroid ointment, with special reference to the intraocular pressure in the treatment of eyelid eczema in patients with atopic keratoconjunctivitis (AKC). Secondary aims were to compare the effects of the treatments on eyelid eczema and their potential impact on ocular surface inflammation. Methods Tacrolimus 0.1% ointment and clobetasone butyrate 0.05% ointment were compared in a double-masked explorative crossover study. In total, 25 AKC patients were included. Each ointment was applied twice daily for 3 weeks, with 2 weeks of washout before, between, and after treatments. Efficacy was determined by eye examination and the patients' own symptom scoring. Cytology and cytokine measurements were performed on tear samples. Safety parameters were intraocular pressure, presence of bacteria and fungi, and the patients' reports of adverse events. The validity of the crossover design was explored with analysis of variance, and the effect of each medication was calculated with paired t-test and Wilcoxon paired test. Results A total of 20 patients completed the study. Both treatments were effective in reducing signs and symptoms of eyelid eczema, with a near superior benefit for tacrolimus in terms of eczema (total skin score) signs (P ¼ 0.05). No serious adverse events occurred and interestingly, intraocular pressure was not evidently affected by either treatment. Conclusion Tacrolimus 0.1% ointment is a promising alternative therapy for eyelid eczema in AKC patients. Long-term studies are needed to further determine the value of tacrolimus in this patient group.

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Topical cyclosporine for atopic keratoconjunctivitis

González‐López

López‐Alcalde²,

Laiz

et al. 2012

Cochrane Database of Systematic Reviews

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Pressure to practice evidence-based medicine is increasing and has the potential to reduce malpractice claims. Sometimes the evidence may prove a specific therapy to be ineffective, but practice says it is effective. In Medicine, however, if you do not trust the evidence, you may expose yourself and your patients to untoward consequences. When we face a complex problem, most of the time it is better to rely on scientific evidence rather than on expert personal opinion.

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Topical tacrolimus treatment of atopic eyelid disease

Cited by 102 publications

References 11 publications

Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Topical 0.005% tacrolimus eye drop for refractory vernal keratoconjunctivitis

Tacrolimus ointment vs steroid ointment for eyelid dermatitis in patients with atopic keratoconjunctivitis

Topical cyclosporine for atopic keratoconjunctivitis

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