ABSTRACT
A 21-year-old and an 11-year-old patients presented with severe,resistant shield ulcers failed to respond to medical treatments which included topical steroids,mast cell stabilizers and antihistamines. Both of them were treated with surgical debridement of the ulcer,supratarsal injection of triamcinolone acetonide,topical cyclosporine 0.5g/L and ketotifen fumerate 0.25g/L. The ulcers healed well after three weeks. Topical cyclosporine was discontinued after two months in both patients. They were symptom free with no recurrence for six months. Combination of surgical debridement of the ulcer,supratarsal injection of triamcinolone acetonide,topical cyclosporine 0.5g/L and ketotifen fumerate 0.25g/L are effective as the treatment option in managing patients with severe vernal shield ulcer.KEYWORDS: vernal shield ulcer; surgical debridement; supratarsal injection of triamcinolone acetonide; cyclosporine; ketotifen fumerate