Montelukast Effective in Vernal Keratoconjunctivitis Associated With Asthma

Laurie Barclay, MD

May 22, 2003

May 22, 2003 — Montelukast effectively treats vernal keratoconjunctivitis (VKC) associated with asthma, according to the results of a small trial published in the May issue of the Archives of Ophthalmology. Based on these findings, the investigators now recommend randomized trials.

"VKC is a chronic bilateral inflammation of the conjunctiva characterized by hyperemia, chemosis, photophobia, filamentous and sticky mucous discharge, and giant papillary hypertrophy of the upper tarsal conjunctiva," write Alessandro Lambiase, MD, from the University "Campus Bio-Medico" in Rome, Italy, and colleagues. "In more than 50% of patients the eye is the only target organ of the allergic inflammation, while in 41.5% of a survey of 195 patients, VKC was associated with other allergic diseases, mainly asthma."

After enrollment in this pilot study, 12 patients with vernal keratoconjunctivitis and asthma discontinued topical eyedrops or any systemic treatment for at least seven days before montelukast treatment.

After 15 days of treatment, eight of 10 patients evaluated reported a reduction in symptoms, including burning, tearing, photophobia, secretion, and redness, while physician-rated hyperemia, secretion, and chemosis also decreased significantly. These improvements were associated with a significant increase in leukotriene B4 in tears and a significant decrease in leukotriene E4 in urine.

Study limitations are those inherent in a small open trial.

"The significant and persistent reduction of ocular signs and symptoms in asthmatic patients with [VKC] treated for 15 days with montelukast strongly suggests the need for double-masked placebo-controlled trials to confirm the potential of this new treatment in [VKC and in] other allergic conjunctivitis, such as atopic keratoconjunctivitis and hay fever conjunctivitis with persistent inflammation and late-phase reaction," the authors write.

Merck & Co. Inc. supported this study by an unrestricted grant. The authors did not report any significant financial disclosures.

Arch Ophthalmol. 2003;121: 615-620

Reviewed by Gary D. Vogin, MD

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