SUPRATARSAL INJECTION OF CORTICOSTEROID IN THE TREATMENT OF REFRACTORY VERNAL KERATOCONJUNCTIVITIS

PURPOSE: We studied supratarsal injection of corticosteroid as a new t herapeutic modality for treating severe vernal keratoconjunctivitis to determine its efficacy in treating patients refractory to all convent ional therapy. METHODS: Twelve patients with vernal keratoconjunctivit is resistant to all established therapy were prospectively studied by randomly assigning them to receive supratarsal injection of either sho rt- or intermediate-acting corticosteroid, Relief of symptoms and reso lution of clinical signs were evaluated. Patients were followed up to four years to identify side effects. RESULTS: All patients experienced dramatic symptomatic relief within one to five days, regardless of th e type of corticosteroid injected. Marked decrease in cobblestone papi llae was noted in 14.9 days (mean) after short-acting corticosteroid i njection and 12.8 days after intermediate acting corticosteroid inject ion (P = .65), Shield ulcers and limbal involvement resolved in one to three weeks, independent of the corticosteroid used (P = .90), No com plications were observed with supratarsal injection of short-acting co rticosteroid. One patient developed persistent increase of intraocular pressure after injection of intermediate-acting corticosteroid. CONCL USIONS: The dramatic symptomatic and clinical improvement suggests tha t supratarsal injection of corticosteroid may be a valuable therapeuti c approach to treating refractory vernal keratoconjunctivitis. Short-a cting and intermediate-acting corticosteroids were equally efficacious . Because of the lack of intraocular pressure increase observed with s hort-acting corticosteroid, we favor its use in supratarsal injection.