Topical Cyclosporine A as a Steroid-Sparing Agent in Steroid-Dependent Idiopathic Ocular Myositis With Scleritis: A Case Report and Review of the Literature

• Published in: Eye & contact lens Vol. 35; no. 5; pp. 275 - 278
• Main Authors: Gumus, Koray, Mirza, G Ertugrul, Cavanagh, H Dwight, Karakucuk, Sarper
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins, Inc 01-09-2009
• Subjects: Administration, Topical; Adult; Anti-Inflammatory Agents - administration & dosage; Cyclosporine - administration & dosage; Dexamethasone - administration & dosage; Drug Administration Schedule; Drug Therapy, Combination; Enzyme Inhibitors - administration & dosage; Eye Movements; Female; Humans; Magnetic Resonance Imaging; Orbital Myositis - complications; Orbital Myositis - drug therapy; Orbital Myositis - physiopathology; Scleritis - complications; Scleritis - diagnosis; Scleritis - drug therapy; Treatment Outcome
• ISSN: 1542-2321; 1542-233X
• DOI: 10.1097/ICL.0b013e3181b4d135

OBJECTIVETo report on a case of idiopathic orbital myositis with scleritis that was effectively controlled with topical 0.05% cyclosporine A and to provide a review of the literature on the treatment of ocular myositis with scleritis.
METHODSA case report.
RESULTSA 35-year-old woman presented with a longstanding history of intractable periorbital pain, redness on her left eye, and diplopia during ocular movement. Her medical history revealed that she had the same symptoms for 5 years and had used numerous prescribed medications for migraine and ocular myositis. During this period, her symptoms and signs had been lessened on systemic steroid treatment, which recurred or worsened after discontinuing or tapering the therapy. Magnetic resonance imaging scans demonstrated an isolated enlargement of the left medial rectus muscle. Laboratory examination results showed no evidence of dysthyroid ophthalmopathy or another systemic disease. Because of adverse affects of systemic corticosteroid and cyclosporine treatments, topical cyclosporine A (0.05%) and dexamethasone were administered four times daily. The patient continued to use topical 0.05% cyclosporine A for 6 months. Using only topical cyclosporine A, she currently has no recurrences of disease on the last examination after 6 months of treatment. Moreover, magnetic resonance imaging revealed a completely normal extraocular muscle configuration.
CONCLUSIONSTopical 0.05% cyclosporine A may be a safe and effective long-term treatment of ocular myositis and scleritis. It should be considered as a steroid-sparing agent, particularly in recurrent disease and in those patients who experience adverse effects of systemic medications.