Effectiveness of Corticosteroid-Sparing Topical Treatments for Vernal Keratoconjunctivitis in Children: A Report by the American Academy of Ophthalmology.

PURPOSE: To review the published literature assessing the efficacy of corticosteroid-sparing topical treatments for vernal keratoconjunctivitis (VKC) in children 18 years of age and younger.

METHODS

A literature search of the PubMed database was last conducted in August 2025 and limited to articles published in English without date restrictions. The search yielded 56 articles, which were reviewed by the primary author in abstract form; 24 were selected for full-text review. Fifteen articles met the inclusion criteria and were assigned a level of evidence rating by the panel methodologist.

RESULTS

Six studies were rated level I, and 9 studies were rated level III. Level I evidence evaluated the efficacy of cyclosporine (4/6), tacrolimus (4/6), interferon alpha-2b (1/6), and sodium cromoglycate (1/6) ophthalmic preparations. Most level III evidence studies (5/9) reported outcomes using tacrolimus drops or ointment. Regardless of the medication, concentration, dosing frequency, or treatment duration, level I and level III evidence included in the assessment demonstrated that signs and symptoms of VKC in children can be improved with intervention. Apart from application site discomfort, the studies reported no significant adverse events.

CONCLUSIONS

Level I and III evidence demonstrate that treatment with corticosteroid-sparing topical interventions such as cyclosporine, tacrolimus, sodium cromoglycate, and interferon alpha-2b can improve clinical signs and symptoms of VKC in children. Most of the level I evidence supports the use of the calcineurin inhibitors-cyclosporine and tacrolimus.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.