How do you approach the use of Cequa in eyes with severe corneal thinning from a prior, healed corneal ulcer?

The use of Cequa or other cyclosporins has not been associated with an increased risk of thinning. Cequa prescribing information lists no contraindications and reports instillation site pain and conjunctival hyperemia as the main adverse reactions. Corneal thinning, impaired healing, and perforation are not listed as adverse reactions in that labeling. A 2024 review describes topical cyclosporine as generally safe for ocular surface disease use. In vitro studies of human corneal epithelial cells...