{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T11:07:12Z","timestamp":1780657632810,"version":"3.54.1"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Klin Monbl Augenheilkd"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The incidence of chronic keratoconjunctivitis, which potentially causes long-term loss of visual acuity due to corneal opacity, is considerably less common in children than in adults. It is therefore in danger of being overlooked. In children the appropriate treatment is therefore often introduced too late, or to an insufficient extent. In this article we would like to raise awareness about the diagnosis of chronic keratoconjunctivitis in children, and to present an effective treatment plan for severe stages of the disease. There are two forms of chronic keratoconjunctivitis that occur most frequently in children: hyperergic blepharokeratoconjunctivitis (hBKC) and vernal keratoconjunctivitis (VKC). With hBKC, the patient often has a history of recurring hordeolum and also presents with blepharitis; it is characterized by the marked presence of corneal neovascularization in the lower circumference of the cornea. VKC is typically characterized by changes under the upper\n\t\t\t\t\teyelid, with marked changes to the superior limbus. If there is a risk of complications involving the cornea, or in the presence of such complications, a consistent long-term topical immunosuppressive and anti-inflammatory treatment is required. Both of these properties are combined in the active ingredient cyclosporine A. Other advantages of topical CSA treatment are its steroid-sparing effect and the long-term reduction of exacerbations. Parents need to be informed about the chronic nature of these two diseases and their tendency to recur; because of these characteristics, treatment, in most cases, should be envisaged for at least one year in order to effectively disrupt the complex immunologic processes. This safeguards the child\u02bcs visual development and prevents amblyopia caused by scarring and astigmatism. We hope that the data presented will lower the barriers related to prescribing CSA for topical eye application in children.<\/jats:p>","DOI":"10.1055\/a-1556-1182","type":"journal-article","created":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T23:58:06Z","timestamp":1635983886000},"page":"1374-1380","source":"Crossref","is-referenced-by-count":5,"title":["Treating Severe Pediatric Keratoconjunctivitis with Topical Cyclosporine A"],"prefix":"10.1055","volume":"239","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5510-3857","authenticated-orcid":false,"given":"Julia","family":"Biermann","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Augenheilkunde, Universit\u00e4tsklinikum M\u00fcnster, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike","family":"Bosche","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Augenheilkunde, Universit\u00e4tsklinikum M\u00fcnster, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Eter","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Augenheilkunde, Universit\u00e4tsklinikum M\u00fcnster, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flemming","family":"Beisse","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Augenheilkunde, Universit\u00e4tsklinikum Heidelberg, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,11,3]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/ICU.0000000000000167","article-title":"Blepharokeratoconjunctivitis in children","volume":"26","author":"K M Hammersmith","year":"2015","journal-title":"Curr Opin Ophthalmol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1038\/eye.2015.249","article-title":"Blepharokeratoconjunctivitis in childhood: corneal involvement and visual outcome","volume":"30","author":"A Rodriguez-Garcia","year":"2016","journal-title":"Eye (Lond)"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s00347-014-3184-z","article-title":"[Vernal keratoconjunctivitis]","volume":"112","author":"U Pleyer","year":"2015","journal-title":"Ophthalmologe"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/j.1755-3768.2008.01347.x","article-title":"Vernal keratoconjunctivitis: a major review","volume":"87","author":"S Kumar","year":"2009","journal-title":"Acta Ophthalmol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/j.1600-0420.2005.00622.x","article-title":"Case series of 406 vernal keratoconjunctivitis patients: a demographic and epidemiological study","volume":"84","author":"A Leonardi","year":"2006","journal-title":"Acta Ophthalmol Scand"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.survophthal.2009.02.002","article-title":"Topical ophthalmic cyclosporine: pharmacology and clinical uses","volume":"54","author":"E Donnenfeld","year":"2009","journal-title":"Surv Ophthalmol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.1167\/iovs.10-5658","article-title":"Effect of topical azithromycin on corneal innate immune responses","volume":"52","author":"Z Sadrai","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1097\/ICO.0b013e3181cda38f","article-title":"Topical azithromycin therapy for meibomian gland dysfunction: clinical response and lipid alterations","volume":"29","author":"G N Foulks","year":"2010","journal-title":"Cornea"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/00003226-198501000-00002","article-title":"Local treatment of necrotizing scleritis with cyclosporin A","volume":"4","author":"F Hoffmann","year":"1985","journal-title":"Cornea"},{"key":"ref10","first-page":"644","article-title":"Treatment of severe vernal keratoconjunctivitis with cyclosporine A eyedrops","volume":"20","author":"D BenEzra","year":"1988","journal-title":"Transplant Proc"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/BF02169821","article-title":"Topical treatment of severe corneal ulcers with cyclosporin A","volume":"227","author":"M Zierhut","year":"1989","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"ref12","first-page":"213","article-title":"[Cyclosporin A eyedrops in the prevention of high-risk corneal graft rejection. 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