Treatment of proliferative feline eosinophilic keratitis with topical 1.5% cyclosporine: 35 cases

Proliferative feline eosinophilic keratitis is a chronic keratopathy caused by a suspected immune mediated response to an unknown antigenic stimulus. The purpose of this study is to demonstrate the efficacy of topical 1.5% cyclosporine solution in proliferative feline eosinophilic keratitis. Thirty-five cats were treated topically with 1.5% cyclosporine A between 1997 and 2007. Eosinophilic keratitis was diagnosed by clinical appearance and evidence of eosinophils and/or mast cells in corneal cytology. The patients were treated with topical cyclosporine (1.5%) twice (26 of 35, 74.3%) and three times (9 of 35, 25.7%) daily. The minimum period for follow-up was 5 months. The age of the patients ranged from 2 to 13 years with a mean age of 6.0 years. Twenty-two were neutered males, and 13 were females. The represented breeds were 30 DSH, 3 DLH, one Siamese and one Maine Coon. Cytologic examination of a corneal scrape revealed the presence of eosinophils in 34 of 35 specimens, and mast cells in 25 of 35 specimens. Improvement in the treated eyes was seen in 31 cats (88.6%). Four animals (11.4%) did not respond to the treatment with topical cyclosporine. Recurrences were seen in seven (22.6%) cases. Blepharitis was noted as an infrequent side effect. Based on our findings, topical cyclosporine (1.5%) is an effective treatment of proliferative feline eosinophilic keratitis in the vast majority of cases. Recurrences were mainly associated with poor owner compliance. Chronic, often lifelong therapy with medications is thus recommended.