the most common ocular adverse event following the use of cyclosporine a ( csa ) 0.05% ophthalmic emulsion is ocular burning ( 17% ) .
other adverse effects that have been reported include conjunctival hyperemia ( 1 - 5% ) , discharge , epiphora , eye pain , foreign body sensation , pruritus , stinging and blurred vision . here , we report a specific side effect of csa , namely eye drop - induced eyelash elongation in a patient with refractory giant papillary conjunctivitis .
a 32-year - old female with giant papillary conjunctivitis on the left eye , who had undergone papillectomy 3 years previously and was refractory to topical steroid therapy , was treated with csa 0.05% ophthalmic emulsion ( restasis ) 4 times a day , preservative - frees artificial tears and gentamicin ophthalmic solution in the left eye .
after 5 months of topical csa treatment , elongated eyelashes of her left eye were observed without other adverse effects .
although hypertrichosis and trichomegaly have been documented in the literature as side effects of systemic csa , topical csa 0.05% eye drop - induced elongated eyelashes have not been reported , and we believe ophthalmologists should be mindful and inform patients about this specific side effect .
a-32-year - old asian female patient , who had received conjunctival papillectomy on the left eye in 2002 , visited our ophthalmic outpatient department in 2007 complaining of a swollen eyelid and discharge from her left eye .
the ocular examination revealed notable injected conjunctiva , especially over the superior part , and multiple papillae with injected and engorged vessels on the left eye ( fig .
, she was started on topical steroid medications including fluorometholone 0.1% and prednisolone acetate 1% ophthalmic solutions for 2 months .
however , steroid treatment was discontinued due to poor response and an elevated intraocular pressure .
therefore , her treatment was switched to topical cyclosporine a ( csa ) 0.05% ophthalmic emulsion ( restasis ) 4 times a day , preservative - free artificial tears and gentamicin ophthalmic solution .
after 5 months of topical csa treatment , she came back to our clinic complaining of elongated and darkened eyelashes on her left eye without other adverse effects ( fig .
2 ) . according to the patient , no systemic medications such as calcium channel blockers , erythropoietin or minoxidil were used during the treatment period .
csa is a hydrophobic , cyclic polypeptide produced as a metabolite by the fungus tolypocladium inflatum .
csa functions as an immunomodulating agent that binds to cyclophilin , a cytoplasmic protein , thus interrupting the signaling for interleukin ( il]-2 production , in addition to inhibiting the proliferation of cd4 t lymphocytes .
it also has direct inhibitory effects on both eosinophil and mast cell activation , which has established its role in the treatment of allergic inflammation [ 2 , 3 ] . in the early 1980s ,
meanwhile , csa eye drops were also prescribed for patients with inflammatory ocular surface disorders , particularly dry eye syndrome and severe allergic keratoconjunctivitis .
the major side effect of systemic csa is nephrotoxicity that is reversible with dosage reduction .
other documented adverse reactions to systemic csa include mild hepatotoxicity , hypertension , dose - dependent hypertrichosis and trichomegaly , tremor , infection , gum hyperplasia , gastric irritation symptoms and neuropathies . on the other hand , adverse events following
the use of csa 0.05% ophthalmic emulsion include ocular burning ( 17% ] , conjunctival hyperemia ( 1 - 5% ] , discharge , epiphora , eye pain , foreign body sensation , pruritus , stinging and blurred vision .
however , to our knowledge , no csa ophthalmic emulsion - induced hypertrichosis has been reported in the literature to date .
suggested that csa induces telogen follicles to enter an anagen growth phase , implying a role of csa in regulating the hair follicle immune system and its cellular components through the release of inhibitory / stimulatory cytokines [ 8 , 9 ] .
the experiments also indicated that the rate of anagen induction is dependent on the dose , time course , and method of administration . in summary , although rarely encountered , csa 0.05% ophthalmic emulsion may induce the growth of eyelashes , and we believe ophthalmologist should be mindful and inform patients treated with topical csa about this side effect .
 purposethe most common ocular adverse event following the use of cyclosporine a ( csa ) 0.05% ophthalmic emulsion is ocular burning ( 17% ) . 
 other adverse effects that have been reported include conjunctival hyperemia ( 1 - 5% ) , discharge , epiphora , eye pain , foreign body sensation , pruritus , stinging and blurred vision . here , we report a specific side effect of csa , namely eye drop - induced eyelash elongation in a patient with refractory giant papillary conjunctivitis.designobservational case report.methodscase report and review of the literature.resultsa 32-year - old female with giant papillary conjunctivitis on the left eye , who had undergone papillectomy 3 years previously and was refractory to topical steroid therapy , was treated with csa 0.05% ophthalmic emulsion ( restasis ) 4 times a day , preservative - frees artificial tears and gentamicin ophthalmic solution in the left eye . 
 after 5 months of topical csa treatment , elongated eyelashes of her left eye were observed without other adverse effects.conclusionalthough hypertrichosis and trichomegaly have been documented in the literature as side effects of systemic csa , topical csa 0.05% eye drop - induced elongated eyelashes have not been reported , and we believe ophthalmologists should be mindful and inform patients about this specific side effect . 