Background: Given the potential adverse effects associated with long-term corticosteroid use, there was need for alternative treatment options that can effectively manage VKC while minimizing the risk of complications. Tacrolimus, a potent immunosuppressive agent, had emerged as a promising alternative due to its ability to modulate the immune response.

Purpose: The purpose of this study was to evaluate the effect of tacrolimus ointment 0.03% as a monotherapy in the treatment of vernal keratoconjunctivitis.

Methodology: Consent was taken from participants. patients who were diagnosed by recurrent vernal keratoconjunctivitis was recruited for study. Slit lamp examination was done to assess the categories of vernal keratoconjunctivitis. Study participants discontinued all the medications one week before beginning treatment. Tacrolimus 0.03% ointment was given for three months and effect on VKC was assessed after 1^st week, 1^st month, 2^nd month and 3^rd month.

Results: In this study minimum age was 5 years and maximum age was 20 years. Gender wise 89% was male and 11% were females. The mean scores of effect of tacrolimus was statistically significant (P Value=0.00). Subjective ocular symptoms and objective ocular signs at the baseline, first week, first month, second and third month had significant association by the usage of tacrolimus ointment. During the follow-ups, no other topical medications were required and no significant changes in visual acuity were documented. No cataracts or elevation of intraocular pressures were detected.

Conclusion: The findings of this study demonstrate the efficacy and safety of topical tacrolimus ointment 0.03% as monotherapy for the treatment of VKC, it could offer an alternative treatment option to corticosteroids and potentially reduce the long-term complications associated with their use. The results of this study may contribute to improving the management and quality of life for individuals affected by VKC, particularly children and young adults.

Keywords: Allergy, Photophobia, Pruritus, Tacrolimus