A 14-year-old Peruvian woman presented with severe redness and photophobia in the last 6 months, with no response to dexamethasone eye drops (Colircusí Dexametasona Esteilvocsi® 0.1 %, Spain).
She reported having had atopic dermatitis and conjunctivitis since she was seven years old, and had had an episode of herpes simplex dermatitis in her left eye (LE) for four years and a corneal ulcer in her right eye (OD).
The patient had erythematous desquamative skin lesions in malar areas, frontal, perilabial, dorsum of the nartz, and dorsum of the hands.
Epidermitis was not observed.
Superficial papilledema, corrected visual acuity was CD at 2 mt in OD and 2/3 in OD, and in limbal biomycosis bulbar, both eyes (A gelatinO) a hyperpigmented conjunctival patch
The RE showed pannus and a central leukoma, and the LE a small paracentral leukoma.
She reported no family history of atopy or other systemic manifestations of atopy.
IgE to common allergens was normal in serum and IgE to normal (Lacrytest, laboratory Adiatec, France).
The dermatology service was consulted. The patient reported having suspected the diagnosis of atopic dermatitis two years prior to the diagnosis of AP, after the result of triple skin biopsy, beginning with topical treatment with 0.03% tacrolimus ointment.
With the diagnosis of ocular AP, in September 2004, we started treatment with cyclosporine A 2% eye drops, prepared in polyvinyl alcohol by the pharmacy service, with an expiration of 28 days, at an initial dose of 1 drop / 8 hours.
In April-05, and still in treatment with cyclosporine eye drops 1%/12h, she presented a reactivation of the condition in OA, which was controlled by increasing eye drops to cyclosporine 2%/8h.
One week later, she developed a central herpetic dermatitis in her left eye that was resolved with a “Wellcome a) ointment” (Zovirax ophthalmic ointment ® Spain, Glaxo 5,Wellcome al).
Since then, cyclosporine eye drops of 1% every 12h and valavir 500 mg/day (Valtrex®, GlaxoSmithKline, USA) have been maintained.
In February 2006 she presented a corrected VA RE of 1/8 and LE of 1/2, and as the only mild inflammatory finding temporal-inferior limbitis in BE.
