Topical cyclosporine in the management of shield ulcers.

Purpose: To report our experience with 0.05%-2% topical cyclosporine in the treatment of 4 cases of severe, corticosteroid-resistant, vernal keratoconjunctivitis with shield ulcers.

Methods: Four patients with shield ulcers not responding to medical treatment with topical steroids, antihistamines, and mast-cell stabilizers were treated with 0.05%-2% topical cyclosporine. The frequency of application was 4 times daily in all cases, and the concentration was adjusted according to the clinical status starting with 2%.

Results: Healing of ulcers with no epithelial defect occurred in 10 days with the 2% concentration in all cases. The patients experienced no side effects except for a burning sensation during administration. Recurrences occurred when the concentration was decreased to 0.05% in 3 cases. The recurrences were effectively treated with 1% concentration in all cases, and patients were stable with this concentration for at least 6 months.

Conclusions: Topical cyclosporine is an effective treatment alternative in the management of shield ulcers in patients with vernal keratoconjunctivitis. The 1% concentration seems to be the minimal effective concentration in such cases in our experience, but further controlled studies are needed to support our findings.