Which of the following is a common ocular immunosuppressant used topically and is also commonly associated with RPLS?

• A. Tacrolimus
• B. Cyclosporine
• C. Sirolimus
• D. Mycophenolate

Answer: (B)

Cyclosporine is the one that fits both parts. In ophthalmology, it’s used topically in eye drops to treat dry eye by blocking calcineurin and dampening T-cell–mediated inflammation on the ocular surface. It’s also the classic calcineurin inhibitor associated with reversible posterior leukoencephalopathy syndrome (RPLS), now more commonly called PRES, especially when used systemically or at high levels in the setting of hypertension or neurotoxicity. The combination of a common topical ocular immunosuppressant with a well-established risk of PRES makes this the best answer. The other agents aren’t the standard topical ocular options and aren’t as clearly linked to PRES in this context.