Introduction: Vernal kerato-conjunctivitis (VKC) is a chronic, bilateral allergic inflammation of the conjunctiva and cornea. For refractory cases, oral or subtarsal corticosteroids are indicated, immunotherapeutic agents like cyclosporine are also used. Recently Tacrolimus is used for the treatment of refractory VKC. It is an immunomodulator with more potency than cyclosporine. Aim __ampersandsignamp; Objective: To assess efficacy and safety of 0.1% tacrolimus ophthalmic ointment in refractory cases of VKC Material and Methods: Present study was a prospective study carried out on refractory cases of vernal kerato-conjunctivitis. Patients were divided into two groups. Group A Patients received Tacrolimus 0.1% ophthalmic ointment twice daily and anti-allergic medications and Group B patients received only allergic medication. Patients were followed up for up to 6 months. At every follow-up, symptoms and signs of both groups were compared. Results: Mean age of the patients in group A was 14.5__ampersandsignplusmn;2.4 years and in the group, B was 15.4__ampersandsignplusmn;3.1 years. Males predominated females in both groups. Patients with tacrolimus treatment showed a statistically significant decrease in symptom score and sign score over 6 months. (p__ampersandsignlt;0.05). Conclusion: Tacrolimus ophthalmic ointment 0.1% is well tolerated and effective in improving objective clinical signs and subjective symptoms of severe VKC refractory to topical antiallergic agents.