Steroid-sparing Topicals Found to be Effective Pediatric VKC Treatment

Calcineuron inhibitors cyclosporine and tacrolimus are the recommended first-line therapy for long-term, nonsteroidal treatment for vernal keratoconjunctivitis. Photo: Paul Karpecki, OD. Click image to enlarge. A recent literature review of corticosteroid-sparing topical treatments’ effectiveness in pediatric vernal keratoconjunctivitis (VKC) indicates that several of them, including cyclosporine and interferon alpha-2b, are viable treatment options. The work was conducted by several ophthalmologists at prominent teaching institutions in the US, including Bascom Palmer, Johns Hopkins, the University of Pennsylvania, UCLA, Duke University and more. The authors searched PubMed for papers that discussed the use of corticosteroid-sparing topicals as VKC treatments, arriving at a total of 15 criteria-meeting articles. They explained in their paper for Ophthalmology that “articles were limited to original research published in English without date restrictions,” with their remaining criteria being that the study “included at least 10 children,” that “the study specifically assessed the efficacy of corticosteroid-sparing topical treatment to improve clinical signs and ocular symptoms of VKC,” and that “the study included at least one month of follow-up.”The authors then categorized each of the 15 accepted studies “based on the scale developed by the 2011 Oxford Centre for Evidence-Based Medicine (CEBM).” Level I was designated the highest quality, including articles from “well-designed and well-conducted randomized clinical trials.” Level II extended to “well-designed case-controlled and cohort studies and lower-quality randomized studies” and level III to “lower-quality cohort and case-controlled studies.” In total, there were six level I studies and nine level III studies, with no qualifying level II studies. This demonstrates a noticeable limitation due to the lack of nonrandomized clinical trial studies that the authors would have described as “well-designed.”Reviewing the results of each study, the authors concluded that corticosteroid-sparing topical products were effective at treating VKC in children 18 years of age and under, successfully reducing symptoms of the condition. Notably, calcineuron inhibitors, such as cyclosporine, were the most strongly supported, although “there was no consensus on dose or formulation.” Problems with application and use of prescribed topicals included intolerance to the topical products, limited availability—one example mentioned that while there were many available cyclosporine eye drops, there was only one existing topical variation of tacrolimus that was meant for application on the skin—and a lack of FDA approval for use in children.While steroid-sparing topical products show promise for pediatric patients, several barriers prevent them from being prescribed on a large scale. As further research is conducted and more evidence becomes available, they may become an approved go-to steroid alternative for patients with not only VKC, but other conditions that affect children’s ocular functioning.Click here for the journal source. Cavuoto K, Oatts J, Nallasamy S, et al. Effectiveness of corticosteroid-sparing topical treatments for vernal keratoconjunctivitis in children. March 9, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.