Figure 2. (A) Early documentation of patient A’s condition showing the initial presentation of chronic ocular issues such as pingueculitis of both eyes or nodular scleritis. (B) The scleritis returned with a corneal melt after a mandated switch to lifitegrast (Xiidra) by insurance. (C) The patient’s condition was significantly improved, although with mild scleral thinning, which was evident 5 weeks after reinstating 0.05% cyclosporine ophthalmic solution as a long-term monotherapy. (D) Patient B presented with a similar area of bilateral scleritis with a phenotypic pinguecula-like overlay as patient A. (E) To avoid chronic immunosuppression, she started 0.05% cyclosporine ophthalmic solution, eliciting a similar significant inflammatory response as seen in patient A. (F) She remains controlled on 0.05% cyclosporine ophthalmic solution as a long-term monotherapy for the last 14 months. OD, right eye; OS, left eye.