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Treatment of Superior Limbic Keratoconjunctivitis With Topical Tacrolimus 0.03% Ointment

Kymionis, George D. MD, PhD; Klados, Nektarios E. MD; Kontadakis, George A. MD, MSc; Mikropoulos, Dimitrios G. MD, PhD

doi: 10.1097/ICO.0b013e318295e6b9
Case Report

Purpose: To report 2 cases of superior limbic keratoconjunctivitis (SLK) treated with topical tacrolimus 0.03% ointment (Protopic; Fujisawa Healthcare).

Methods: A female patient aged 52 years and a male patient aged 21 years presented with SLK in both eyes. Both patients had previously received several treatments [such as topical steroids and lubrication, contact lenses, silicone punctal plugs, and vitamin A eye drops], with no improvement. Because of poor response to initial management, the authors started treatment with topical tacrolimus 0.03% twice a day. Objective tarsal conjunctiva inflammation, bulbar conjunctiva findings (such as hyperemia and thickening), cornea staining, and subjective symptoms were evaluated.

Results: A week later, both patients were symptomatically better. Four weeks after treatment initiation, the signs of thickened and hyperemic superior conjunctiva, papillary reaction, and punctate keratopathy were almost resolved. Tacrolimus was successfully tapered in both the patients. There were no side effects.

Conclusions: Topical tacrolimus 0.03% ointment may be considered an additional treatment option for SLK.

*Department of Ophthalmology, University Hospital of Heraklion, University of Crete, Crete, Greece; and

OKEBE, Ophthalmology Center of Northern Greece, Thessaloniki, Greece.

Reprints: George D. Kymionis, Institute of Vision and Optics (IVO), University of Crete, Medical School, 71003 Heraklion, Crete, Greece (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received January 27, 2013

Accepted April 05, 2013

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.