Table 1.

Summary of ocular therapeutic effects of immunomodulators.

Immunomodulator	Mechanism	Studied Ocular Therapeutic Effects
Cyclosporine	Calcineurin inhibitor	Decreases levels of IL-4, IL-5, IL-17A, TNF-alpha, interferon gamma, and eotaxin in the tear film, as well as reduces density of inflammatory cells within the conjunctiva, thereby effectively treating VKC [79,92,139].
Tacrolimus	Calcineurin inhibitor	Effective in refractory cases of VKC [140,141,142,147].
Sirolimus (rapamycin)	Inhibits mTORC1	Blocks IL-2 and inflammatory effects on the ocular surface, but it is not yet established in VKC treatment [158,161].