title: Topical cyclosporin as an alternative treatment for vision threatening blepharokeratoconjunctivitis: a case report.
abstract: Here, a case of vision threatening blepharokeratoconjunctivitis that responded well to topical cyclosporin is reported. A 9-year-old Malay girl with a history of bilateral blepharokeratoconjunctivitis was regularly treated with lid scrubbing using diluted baby shampoo, fusidic acid gel, and topical steroids as well as an intermittent course of oral doxycycline for the past year. She developed acute onset bilateral eye redness associated with poor vision in her right eye. Both eyes showed marked diffuse hyperemic conjunctiva with corneal vascularization. The presence of corneal vascularization obscured the visual axis in the right eye. The condition did not improve with regular intensive lid hygiene using diluted baby shampoo, fusidic acid gel, and topical steroids. She was started on topical cyclosporin A 0.5% every 6 hours. There was a dramatic regression of corneal vascularization after 3 days on topical cyclosporin, with marked improvement in visual acuity. This is a single case in which cyclosporin improved the status of the ocular surface. A large cohort study is required to justify its effectiveness in treating blepharokeratoconjunctivitis and to test its potential as an alternative immunosuppressive agent in comparison to conventional corticosteroids.
authors.affiliation: Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan ; Department of Ophthalmology, Hospital Pulau Pinang, Jalan Resindensi, Pulau Pinang, Malaysia.
authors.forename: Abdul-Salim
authors.initials: AS
authors.lastname: Ismail
authors.forename: Rohana
authors.initials: R
authors.lastname: Taharin
authors.forename: Zunaina
authors.initials: Z
authors.lastname: Embong
keywords: blepharokeratoconjunctivitis; cyclosporin