CASE REPORTS Treatment of Atopic Eyelid Disease Using Topical Tacrolimus Following Corticosteroid Discontinuation in a Patient With Open-Angle Glaucoma George D. Kymionis, MD, PhD, Miltiadis K. Tsilimbaris, MD, PhD, Olga E. Iliaki, MD, PhD, Emmanuelle Christodoulakis, MD, Charalambos S. Siganos, MD, PhD, and Ioannis G. Pallikaris, MD, PhD Purpose: To report a case of atopic eyelid disease treatment using topical tacrolimus in a patient with open-angle glaucoma following corticosteroid discontinuation. Design: Interventional case report. Methods: A 59-year-old white man with a history of treated open- angle glaucoma (latanoprost 0.005%) was referred to our department for atopic eyelid disease. The patient had received previous treatment with topical corticosteroid ointments (hydrocortisone acetate 1%/dexamethasone 0.1% ointments) that, even though they were ef- fective in controlling atopic eyelid disease, were complicated by markedly elevated intraocular pressure (IOP) (steroid responder). Topical steroids were discontinued while other treatment modalities (such as eyelid hygiene, artificial tears, topical antihistamine drugs, topical mast cell stabilizers, or topical/oral antibiotics) were proven ineffective. Results: Topical tacrolimus 0.03% ointment (Protopic; Fujisawa, Dublin, Ireland) was applied to the eyelid skin twice daily. An im- provement of eyelid inflammation was observed while eczematous skin lesions and erosions were resolved within 15 days. After 6 months of continued topical tacrolimus treatment, there was no evi- dence of atopic dermatitis recurrence. During this period IOP re- mained controlled without any evidence of deregulation. Conclusions: Treatment of atopic eyelid disease with topical tacro- limus, following corticosteroid discontinuation in a steroid responder patient with open-angle glaucoma, seems to be an effective alterna- tive treatment to corticosteroids without the risk of IOP increase. Key Words: atopic eyelid disease, corticosteroids, glaucoma, tacro- limus (Cornea 2004;23:828–830) A topic dermatitis (AD) is a common chronic relapsing in- flammatory skin disorder that is characterized by eczema- tous skin lesions with pruritus. Ocular complications include eyelid (hyperemia, eczema, trichiasis, ectropion), conjunctival (atopic keratoconjuctivitis, conjuctival papillary formation, chemosis, hyperemia, symblepharon), limbus (trantas dots), corneal (superficial punctate keratopathy, epithelial defect, keratoconus, peripheral neovascularization), and tear film ab- normalities. 1 Antibiotics, corticosteroids, antihistamines, and less commonly immunosuppressive drugs comprise the treatment modalities for atopic dermatitis. Application of topical steroids to the affected area is usually sufficient for the majority of cases. However, their chronic use may be associated with sig- nificant side effects at the application site. Skin atrophy and other undesirable effects are frequently seen after long-term corticosteroid treatment. In addition, long-term application of topical corticosteroids to the eyelids for atopic dermatitis has been correlated with the development of glaucoma. 2,3 In this case report, we describe our successful experi- ence with topical tacrolimus treatment of atopic eyelid disease in a patient with open-angle glaucoma following corticosteroid discontinuation. CASE REPORT A 59-year-old man was referred to our department for the treatment of atopic eyelid disease. The patient had a history of glaucoma, which was well controlled with medications (la- tanoprost 0.005% once a day), and atopic eyelid disease for the last couple of years. The only effective treatment of the atopic eyelid disease was topical application of corticosteroids (hy- drocortisone acetate 1%/dexamethasone 0.1% ointments), Received for publication November 17, 2003; revision received February 18, 2004; accepted February 18, 2004. From the University of Crete, School of Health Sciences, Division of Medi- cine, Department of Ophthalmology, Crete, Greece. The authors have no financial or proprietary interest in any materials or meth- ods described herein. Dr. George Kymionis is supported by a grant from Bardinogiannis Founda- tion, Athens, Greece. Reprints: George D. Kymionis, MD, PhD, University Of Crete, School of Health Sciences, Division of Medicine, Department of Ophthalmology, 71110 Heraklion, Crete, Greece (e-mail: kymionis@med.uoc.gr). Copyright © 2004 by Lippincott Williams & Wilkins 828 Cornea • Volume 23, Number 8, November 2004