Les modalités d’utilisation de la ciclosporine locale pour l’allergie oculaire

Abstract

Of the common allergic conjunctivitis in children, rare forms present more severe prognosis which include vernal keratoconjunctivitis and atopic keratoconjunctivitis. Vernal keratoconjunctivitis affects children mainly boys from 3 to 15 years old and represents a serious, descolarizing pathology affecting quality of life of the child. Atopic keratoconjunctivitis clearly affects adults more frequently with moderate to severe degrees of severity. Thus, the last few years have had the objective of developing innovative therapies to improve the management of these severe keratoconjunctivitis. It is essential to recognize the clinical form of these eye allergies for the implementation of appropriate treatment. Topical corticosteroids, although most often effective, can create dependence and moreover cause iatrogenic or even severe visual impairment complications. The latest studies on ciclosporin which is an immunosuppressive agent, have demonstrated major steroid-sparing effects. The proper use of topical cyclosporine must be well monitored. Nowadays, topical ciclosporine at 0.1%, has received the AMM for the indication of vernal keratoconjunctivitis and a new dosage at 2% received the AMM for the treatment of keratoplasty. Tacrolimus ointment having more powerful effects than cyclosporine is of interest in severe vernal keratoconjunctivitis and in fact especially in atopic keratoconjunctivitis. Therefore, in addition Tacrolimus treats atopic eyelid eczema. The various latest generation antiallergics can be useful in combination in ocular allergy. In very severe cases, Omalizumab, a human monoclonal antibody produced by the so-called recombinant DNA technique, selectively binds human immunoglobulin E (IgE) and has shown its effectiveness combined with ciclosporine in recent studies. Topical ciclosporine used appropriately can be a steroid-sparing agent in severe ocular allergy and improve the quality of life of children.