Persistent limbal nodule in vernal keratoconjunctivitis that was improved with topical tacrolimus: A case report
Purpose: To report our experience of managing a persistent limbal nodule associated with vernal keratoconjunctivitis (VKC) by topical tacrolimus eye drops. Methods: Case report. Results: A 9-year-old girl was referred to the hospital with the major complaints of photophobia and itching in eyes and foreign body sensation, redness, and ptosis in the left eye. She had a two-year history of gradually enlarging solitary limbal gelatinous mass on the nasal side of the limbus in a left eye, which according to the other signs and impression cytology (IC) was diagnosed as a VKC. This case highlights an isolated limbal nodule as an unusual presentation of vernal keratoconjunctivitis. As the disease in her left eye was more severe and persistent with maximum topical steroid usage, we started the topical tacrolimus (0.05%) eye drop, that a rapid therapeutic result was observed. After using the topical tacrolimus, all ocular surface inflammation and other symptoms rapidly disappeared and at 12-months follow-up, there was no recurrence of the limbal mass lesion and other symptoms and signs of VKC. Conclusion: The limbal mass like nodule may be the only obvious manifestation of VKC and should be considered in the differential diagnosis. In a refractory VKC, aqueous formulation of topical tacrolimus can be used and enhance remission in such complex cases and can resolve the patient’s complaints, rapidly.
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