title: Topical tacrolimus ointment for treatment of intractable atopic keratoconjunctivitis: a case report and review of the literature.
abstract: OBJECTIVE
  To report the utility of tacrolimus 0.03% dermatologic ointment (Protopic) in a case of refractory atopic keratoconjunctivitis with giant papillae. A review of the medical literature is presented.
  
  
  METHODS
  A 32-year-old man with a long-standing history of severe atopic disease was referred to our department because of bilateral intense eye pain, itching, photophobia, and epiphora. Biomicroscopy examination showed conjunctival hyperemia, superficial punctata keratitis, and tarsal giant papillae. This patient had undergone previous treatment with systemic and topical steroids, antihistamines, topical antihistamine/mast cell stabilizer drops, cyclosporine A, and even surgical resection-cryopexy of giant papillae-without success.
  
  
  RESULTS
  The patient was started on tacrolimus 0.03% ointment treatment of the conjunctival fornix twice daily. After 2 months, the patient experienced resolution of his clinical symptoms with a significant decrease in papillae size. No side effects were reported. Treatment was continued for 1 month and gradually reduced with increasingly wide intervals between applications. Eight months after treatment, there were no signs of reactivation, and the patient remains asymptomatic.
  
  
  CONCLUSIONS
  Application of tacrolimus 0.03% dermatologic ointment into the lower fornix seems to constitute an interesting alternative treatment for atopic keratoconjunctivitis that is refractory to traditional treatment.
authors.affiliation: Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza, Spain. dianapgpe@hotmail.com
authors.forename: Diana Pérez
authors.initials: DP
authors.lastname: García
authors.forename: Juan Ibáñez
authors.initials: JI
authors.lastname: Alperte
authors.forename: José A
authors.initials: JA
authors.lastname: Cristóbal
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Mateo Orobia
authors.forename: Enrique Mínguez
authors.initials: EM
authors.lastname: Muro
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Valyi
authors.forename: Beatriz Jiménez
authors.initials: BJ
authors.lastname: Del Rio
authors.forename: María Rojo
authors.initials: MR
authors.lastname: Arnao
mesh_terms: D000287:Administration, Topical; D000328:Adult; D002908:Chronic Disease; D003228:Conjunctiva / Q000187:drug effects; D003233:Conjunctivitis, Allergic / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D009824:Ointments; D016559:Tacrolimus / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus