Conjunctival lymphoid hyperplasia treated with topical tacrolimus: A report of two cases.

Purpose: Conjunctival lymphoid hyperplasia is a benign condition that typically presents with irritation, conjunctival injection, and eyelid edema. Topical corticosteroid drops are often the first-line treatment when not excised, but long-term use may cause intraocular pressure spikes or cataract formation. Steroid-sparing agents could be considered to manage patients who require long-term treatment. Here we discuss the potential benefit of topical tacrolimus use for the management of these patients. Observations: We present two cases of conjunctival lymphoid hyperplasia, one in a 74-year-old man and one in a 41-year-old woman. Both showed a positive response to topical steroid treatment, but due to intraocular pressure elevations, needed to be trialed on steroid-sparing medications. Topical tacrolimus (Protopic) at 0.03 % concentration was applied to the inferior fornix. Patients were monitored for improvement on exam and for subjective improvement of their symptoms. Topical tacrolimus produced moderate to complete resolution of the lesions in these patients and resulted in symptomatic improvement. Conclusions and importance: Tacrolimus is an immunomodulatory medication. The ointment form is approved for use in atopic dermatitis (eczema). Although it is an off-label use, it has been used for other ocular conditions with variable success and tolerability, but we did not find any prior reports of its use in conjunctival benign lymphoid hyperplasia.