Use of Topical Cyclosporin and Tacrolimus for Recurrent Subepithelial Infiltrates after Epidemic Keratoconjunctivitis

Purpose: To report a case of recurrent subepithelial infiltrates (SEIs) after epidemic keratoconjunctivitis (EKC), which improved with the use of topical cyclosporin and tacrolimus. Case summary: A 33-year-old female patient with bilateral EKC developed multiple SEIs, which were worse in the left eye, after applying topical antibiotics and steroid for 3 weeks. She was administered 0.5% loteprednol etabonate every 2 hours, which was gradually tapered to once a day, and 0.1% cyclosporine once daily. However, the SEIs recurred. Therefore, 0.1% cyclosporine was administered twice a day in both eyes and the frequency of administration of steroid eye drops was increased. The dose of steroid eye drops was reduced, but two attempts to taper the dose failed. SEIs in the right eye improved with the use of 0.1% cyclosporine. However, SEIs in the left eye recurred on tapering the steroid dose. Therefore, topical 0.02% tacrolimus ointment was administered once daily in the left eye. After 2 weeks of using tacrolimus, the topical steroids were discontinued. SEIs were well-controlled for 6 months with 0.1% cyclosporine administered 1-2 times/day in the right eye and 0.02% tacrolimus administered 1 time/3 days in the left eye. Conclusions: Topical cyclosporine and tacrolimus can minimize the requirement for steroids, and treat chronic and recurrent SEIs after EKC.