This protocol applies to severe, sight-threatening atopic keratoconjunctivitis in which a prior course of topical therapy — including topical cyclosporine 2% — has not produced sufficient reduction in signs and symptoms, and further escalation of care is required.
The preceding step used topical corticosteroids to control acute exacerbation alongside topical cyclosporine 2% (or the commercially available 0.05% formulation at more frequent dosing intervals). The defined treatment goal — meaningful reduction in signs and symptoms within two weeks of cyclosporine 2% use — was not reached, signalling the need for a different approach.
When sight-threatening atopic keratoconjunctivitis remains uncontrolled after topical treatment, an alternative method of delivering corticosteroid — by a non-topical route — may be considered. The complete protocol specifies the exact approach, patient selection, and clinical decision points.
For severe sight-threatening atopic keratoconjunctivitis that is not responsive to topical therapy, supratarsal injection of corticosteroid can be considered.
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