Vernal keratoconjunctivitis (VKC) is a severe ocular, chronic, relapsing disease that can result in loss of visual acuity and blindness. Treatment with topical antihistamines, mast-cell stabilizers, corticosteroids, or even topical immunosuppressors (ie, cyclosporine or tacrolimus) frequently does not improve VKC symptoms, and partial control of symptoms with oral corticosteroids can induce severe adverse events with long-term use.1 Omalizumab is a humanized monoclonal antibody directed toward IgE and is approved for treating severe allergic asthma and severe chronic idiopathic urticaria.2