1. Topical Tacrolimus 0,03% for Treatment of Refractory Allergic Conjunctivitis Diane Marinho, Andréia Ferreira Laranjeira, Sérgio Kwitko, Samuel Rymer Hospital de Clínicas de Porto Alegre Federal University of Rio Grande do Sul - Porto Alegre - Brazil The authors have no financial interest in the subject matter of this poster

2. Treatment of severe allergic conjuntivitis is a big challenge, since eyedrops containing antihistamines or sodium chromoglycate and its derivates are often insufficient. The addition of corticoids is often required, but the risk of glaucoma, cataract or atrophy of the skin limits the use of corticoids to short courses. PurposePurpose To evaluate the efficacy of topical tacrolimus 0,03% in the treatment of allergic conjunctivitis refractory to conventional treatment or dependent of corticosteroids. Topical Tacrolimus for Allergic Conjunctivitis 1.Virtanen H et al. Effect of 0,03% tacrolimus ointment on conjunctival cytology in patients with severe atopic blepharoconjunctivitis: a retrospective study. Acta Ophthalmol. Scand 2006;84: 693-695. 2. Tacrolimus Ointment 0,03% in the Eye for Treatment of Giant Papillary Conjunctivitis Cornea 2008; 27: 228-229.

3. Methods 13 patients with ocular allergy 9 vernal conjunctivitis 3 chronic atopic conjunctivitis 1 allergic dermatoconjunctivitis Topical tacrolimus 0,03% twice daily Clear of topical antihistamines and corticoids for at least one week Follow-up between 6-16 months Ophthalmological examination in days 15 th, 30ty and monthly after Topical Tacrolimus for Allergic Conjunctivitis

4. ResultsResults Patients referred total symptoms relief after a mean follow-up time of 2 weeks. Two patients referred burning sensation and interrupted the eyedrops in the first two weeks of treatment. No other medications were necessary for ocular allergy control. One patient showed ponderal gain of 12 pounds and school improvement since tacrolimus introduction. No one restarted with corticoids or antihistamines eyedrops during treatment with tacrolimus. After two weeks of the begining, seven patients related reduced burning sensation with topical tacrolimus. No adverse event due to local imunossupression, in visual acuity or in refraction was observed. Topical Tacrolimus for Allergic Conjunctivitis

5. Table 1: Patients caracteristics and follow-up Patients Age(Yrs) Gender Conjunctivitis Previous history Follow-up (months) Incident or Adverse event 1 6 M VERNAL 1,2,4,5,6 16 Burning sensation 1st week 2 8 M VERNAL 1,2,4,5 16 - 3 16 M VERNAL 1,3,5,7 16 Tacrolimus sttoped for 2 months: new crisis 4 24 M ALLERGIC 1,2,3,4,5 14 Burning sensation for 2 weeks 5 22 F ATOPIC 1,4,5,6 14 - 6 18 M VERNAL 1,2,3,4,5 - Sttoped in 2 weeks (burning) 7 11 F VERNAL 1,2,4,5 11 Burning sensation 1st week 8 8 M VERNAL 3,4,5,6 8 Burning sensation for 3 weeks 9 18 M ATOPIC 1,2,3,5 - Sttoped in the first week (burning) 10 19 M ATOPIC 1,2,3,4,5,6,7 10 - 11 16 M VERNAL 1,3,4,5,6 9 - 12 9 M VERNAL 2,4,5 9 Burning sensation 1st week 13 7 M VERNAL 1,3,4,5 - Burning sensation for 2 weeks 1- Rinitis 2- Asthma 3- Atopic dermatitis 4- Corticoid use >3 times/year 5- Cronic use of antihistamines or mast cells stabilizers eyedrops 6- Corneal ulcer 7- Cataract Yrs= years M=male F=female Patients Age(Yrs) Gender Conjunctivitis Previous history Follow-up (months) Incident or Adverse event 1 6 M VERNAL 1,2,4,5,6 16 Burning sensation 1st week 2 8 M VERNAL 1,2,4,5 16 - 3 16 M VERNAL 1,3,5,7 16 Tacrolimus sttoped for 2 months: new crisis 4 24 M ALLERGIC 1,2,3,4,5 14 Burning sensation for 2 weeks 5 22 F ATOPIC 1,4,5,6 14 - 6 18 M VERNAL 1,2,3,4,5 - Sttoped in 2 weeks (burning) 7 11 F VERNAL 1,2,4,5 11 Burning sensation 1st week 8 8 M VERNAL 3,4,5,6 8 Burning sensation for 3 weeks 9 18 M ATOPIC 1,2,3,5 - Sttoped in the first week (burning) 10 19 M ATOPIC 1,2,3,4,5,6,7 10 - 11 16 M VERNAL 1,3,4,5,6 9 - 12 9 M VERNAL 2,4,5 9 Burning sensation 1st week 13 7 M VERNAL 1,3,4,5 - Burning sensation for 2 weeks 1- Rinitis 2- Asthma 3- Atopic dermatitis 4- Corticoid use >3 times/year 5- Cronic use of antihistamines or mast cells stabilizers eyedrops 6- Corneal ulcer 7- Cataract Yrs= years M=male F=female

6. Topical Tacrolimus for Allergic Conjunctivitis Figures 01.: Patient 1 30d e 120 d pos treatment Figures 1. Patient 3 30 and 120 days pos treatment

7. Topical Tacrolimus for Allergic Conjunctivitis Figures 2: Patient 2 pre treatment and 15 days pos treatment Figures 3: Patient 2 pre treatment and 30 days pos treatment

8. Topical Tacrolimus for Allergic Conjunctivitis Conclusion:Conclusion: The tacrolimus 0,03% eyedrops appears to be an effective and safe alternative for allergic conjunctivitis refractory to traditional treatment or corticoid dependent.