Tear tryptase in vernal keratoconjunctivitis.
OBJECTIVE
To determine the tear level of tryptase (a marker of mast cell activation) in vernal keratoconjunctivitis (VKC) before and after treatment. In addition, eosinophil counts in conjunctival scrapings and ocular surface temperature before and after treatment were studied.


METHODS
A total of 20 patients, 7 years or older with VKC, were included in this study. Tear samples for tryptase determination were collected before and 2 weeks after treatment with 4% disodium cromoglycate eyedrops and 0.1% fluorometholone eyedrops. In addition, conjunctival scrapings were obtained for microscopic evaluation, and measurement of the ocular surface temperature was performed before and 2 weeks after treatment. One patient was excluded because the patient did not receive topical treatment. Control tear samples were collected from 20 normal control patients for tryptase determination.


RESULTS
There were 19 patients with VKC (17 males, 2 females). The age range was 7 to 17 years with a mean age of 9 years. The mean number of eosinophils prior to initiation of therapy was 11.37 eosinophils with a range of 1 to 34 per high-power field. Following treatment, the mean number of eosinophils was 3.42 eosinophils per high-power field with a range of 0 to 11 (P<.01). The mean ocular surface temperature for the right eye before treatment was 35.56 degrees C (range, 34.46 degrees C-36.50 degrees C) and after treatment was 33.53 degrees C (range, 31.13 degrees C-35.40 degrees C). For the left eye, the mean ocular surface temperature before treatment was 35.49 degrees C (range, 34.86 degrees C-36.16 degrees C) and after treatment was 33.88 degrees C (range, 32.40 degrees C-35.53 degrees C). The ocular surface temperature was found to decrease significantly following treatment (P<.001). The levels of tryptase in tears of patients with VKC were determined before and after treatment. The mean level was 16.77 ng/mL (range, <5-115 ng/mL). Following treatment with topical 4% disodium cromoglycate and 0.1% fluorometholone eyedrops, the mean level of tryptase decreased to 7.29 ng/mL (range, <5-44.1 ng/mL) (P<.05).


CONCLUSIONS
Patients with severe VKC had high levels of tryptase in tears. Following treatment, the level of tryptase in tears decreased significantly.
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11534, Saudi Arabia. k.tabbara@nesma.net.sa
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D000293:Adolescent; D000485:Allergens / Q000009:adverse effects; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D002648:Child; D003233:Conjunctivitis, Allergic / Q000188:drug therapy / Q000201:enzymology* / Q000209:etiology; D004205:Cromolyn Sodium / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004804:Eosinophils; D005260:Female; D005469:Fluorometholone / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009883:Ophthalmic Solutions; D012697:Serine Endopeptidases / Q000378:metabolism*; D013666:Tears / Q000201:enzymology*; D053802:Tryptases
D000485:Allergens; D018926:Anti-Allergic Agents; D009883:Ophthalmic Solutions; D012697:Serine Endopeptidases; D053802:Tryptases; D004205:Cromolyn Sodium; D005469:Fluorometholone