Treatment of atopic eyelid disease using topical tacrolimus following corticosteroid discontinuation in a patient with open-angle glaucoma.
OBJECTIVE
To report a case of atopic eyelid disease treatment using topical tacrolimus in a patient with open-angle glaucoma following corticosteroid discontinuation.


METHODS
Interventional case report.


METHODS
A 59-year-old white man with a history of treated open-angle glaucoma (latanoprost 0.005%) was referred to our department for atopic eyelid disease. The patient had received previous treatment with topical corticosteroid ointments (hydrocortisone acetate 1%/dexamethasone 0.1% ointments) that, even though they were effective in controlling atopic eyelid disease, were complicated by markedly elevated intraocular pressure (IOP) (steroid responder). Topical steroids were discontinued while other treatment modalities (such as eyelid hygiene, artificial tears, topical antihistamine drugs, topical mast cell stabilizers, or topical/oral antibiotics) were proven ineffective.


RESULTS
Topical tacrolimus 0.03% ointment (Protopic; Fujisawa, Dublin, Ireland) was applied to the eyelid skin twice daily. An improvement of eyelid inflammation was observed while eczematous skin lesions and erosions were resolved within 15 days. After 6 months of continued topical tacrolimus treatment, there was no evidence of atopic dermatitis recurrence. During this period IOP remained controlled without any evidence of deregulation.


CONCLUSIONS
Treatment of atopic eyelid disease with topical tacrolimus, following corticosteroid discontinuation in a steroid responder patient with open-angle glaucoma, seems to be an effective alternative treatment to corticosteroids without the risk of IOP increase.
Kymionis
George D
GD
University of Crete, School of Health Sciences, Division of Medicine, Department of Ophthalmology, Crete, Greece. kymionis@med.uoc.gr
Tsilimbaris
Miltiadis K
MK
Iliaki
Olga E
OE
Christodoulakis
Emmanuelle
E
Siganos
Charalambos S
CS
Pallikaris
Ioannis G
IG
D000287:Administration, Topical; D003876:Dermatitis, Atopic / Q000150:complications / Q000188:drug therapy*; D005141:Eyelid Diseases / Q000150:complications / Q000188:drug therapy*; D005902:Glaucoma, Open-Angle / Q000150:complications* / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use*
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016559:Tacrolimus