Systemic Cyclosporin a in Severe Atopic Keratoconjunctivitis

Abstract

Severe atopic keratoconjunctivitis (AKC) is associated with atopic dermatitis and is often refractory to topical treatment and potentially blinding. Because T lymphocytes are central in the pathogenesis of these diseases, systemic cyclosporin A (CSA) should treat both dermatologic and ocular manifestations. We describe the successful treatment of 8 patients with severe AKC, resistant to conventional management, with systemic CSA. This was a retrospective observational case series. The notes of patients with severe AKC were reviewed, where the disease did not respond to topical or other systemic treatment, and was treated with systemic CSA. Response to such treatment was observed and reported in 8 patients. Cyclosporin A was effective as a steroid-sparing agent. Systemic corticosteroids were stopped in half of the patients. Dosage varied between 50 mg and 300 mg daily (in divided doses), and duration of treatment varied between 5 months and 7 years. Papillary blepharoconjunctivitis and punctuate keratopathy completely resolved a few weeks after CSA therapy. Corneal ulcers resolved after 5 to 10 weeks of treatment. Coexistent eczema or dermatitis was brought under control with systemic immunosuppression, and flare-ups were not present during the duration of treatment. There was remission of AKC in all 8 patients with increase in visual acuity and low incidence of side effects. Cyclosporin A is effective in the treatment of atopic dermatitis and keratoconjunctivitis. Our case series potentiates previous smaller case series that systemic CSA can be used effectively and safely in cases that are resistant to conventional treatment to preserve vision.