To report a case of refractory idiopathic T cell mediated chronic conjunctivitis causing limbal insufficiency, which improved with cyclosporine therapy.

A 43-year old man complained of conjunctival injection and discomfort in both eyes that lasted three years and was refractory to topical steroids, antibiotics, and artificial tears. There was no evidence of connective tissue diseases, Stevens-Johnson syndrome, pemphigoid, or drug history. Both eyes presented with diffuse injection and thickening of the conjunctiva, punctuated epithelial erosion of the conjunctiva and cornea, severe limbal epithelitis and elevated intraocular pressure. The left cornea was conjunctivalized due to limbal deficiency. Histological examination revealed severe infiltration of T and B cells, without any evidence of tumor cells or basement membrane anomaly. When treated with oral cyclosporine, injection and thickening of the conjunctiva decreased and the intraocular pressure was normalized. The surface inflammation of both eyes completely resolved two months after the treatment was initiated.

In chronic idiopathic conjunctivitis with limbitis resistant to conventional treatment and T cell infiltration found in pathological examination, oral cyclosporine therapy might be required to resolve inflammation.