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Topical 0.03% tacrolimus ointment in the management of ocular surface inflammation in chronic GVHD

Bone Marrow Transplantation volume 45, pages 957–958 (2010)Cite this article

We present a case in which topical tacrolimus 0.03% was used successfully in the management of ocular surface inflammation from chronic GVHD. Dry eye is the most common complication of chronic GVHD, occurring in 40–76% of patients.1 Inflammation of the ocular surface leads to aqueous deficiency and tear film instability; blindness could ensue from conjunctival cicatrization and corneal epithelial breakdown.2 The mainstay of treatment for ocular surface GHVD consists of lubrication and topical steroid,3 but the long-term use of the latter is limited by complications, such as cataract and glaucoma. Protopic (Tacrolimus 0.03%, Astellas Pharma, Tokyo, Japan) is a dermatological ointment approved by the US Food and Drug Administration for atopic eczema. Off-label ophthalmic use has emerged for eczematous eyelid disease, atopic keratoconjunctivitis and various other anterior segment inflammations with promising results.3, 4 Its twice-daily regimen, higher potency than commercially available calcineurin inhibitor (CYA 0.05%), lack of serious side effects and steroid sparing properties have made it ideal for at least short-term use when other modalities fail.

Reports on the efficacy of topical tacrolimus in ophthalmic diseases exist for both dermatological3 and specially prepared ophthalmic ointments.4 The most frequently reported side effect from the dermatological ointment was the blurring of vision caused by the viscous base, and a burning sensation, both of which were tolerated. Concerns are raised regarding the increased susceptibility to infection and skin malignancy as a result of local immunological suppression. The longest treatment duration for ocular use was 26 months in a 46-year-old man with peripheral ulcerative keratitis in whom no significant adverse effects were noted. Results from controlled long-term studies are, however, lacking.

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Authors and Affiliations

  1. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China

    P M K Tam, A L Young, L L Cheng & P T H Lam

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  1. P M K Tam
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  2. A L Young
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  3. L L Cheng
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  4. P T H Lam
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Correspondence to A L Young.

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The authors declare no conflict of interest.

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This study was presented as a poster at the 10th International Ocular Inflammation Symposium, Prague

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Tam, P., Young, A., Cheng, L. et al. Topical 0.03% tacrolimus ointment in the management of ocular surface inflammation in chronic GVHD. Bone Marrow Transplant 45, 957–958 (2010). https://doi.org/10.1038/bmt.2009.249

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