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The objectives of this study were to determine: 1) levels of tear eosinophil cationic protein (ECP) in patients with vernal keratoconjunctivitis (VKC); 2) the effect of pharmacologic therapy on ECP release; and 3) the correlation of this mediator with the severity of the disease. Tears were collected from 10 controls and 20 VKC patients before and after therapy for cytologic analysis and ECP measurement by radioimmunoassay. Ocular signs and symptoms were evaluated before tear collection. Mean ECP levels in controls were 7.5 +/- 0.4 microgram/l, and in VKC patients, 988.3 +/- 128 micrograms/l before therapy (P < 0.001) and 566.3 +/- 121 micrograms/l after therapy (P < 0.005). In dexamethasone (Dex) 0.1% or cyclosporin A (CsA) 2% patients (five per group), tear ECP decreased significantly after 7-14 days of treatment. Disodium cromoglycate (DSCG) 4% (five patients) for 14 days did not significantly affect ECP levels. ECP levels were significantly correlated with allergic signs (P < 0.001), symptoms (P < 0.001), and the number of eosinophils in tears (P < 0.005). The results of this study suggest that tear ECP levels accurately reflect the clinical status of VKC patients. The measurement of ECP may prove useful not only in the diagnosis and monitoring of allergic disease, but also as an objective parameter for the evaluation of new antiallergic therapies.

Aim-To validate the use of tear eosinophil cationic protein (ECP) as a marker for eosinophil activation, and its pharmacological modulation, in addition to evaluating the eYcacy of lodoxamide and sodium cromoglycate in the treatment of vernal keratoconjunctivitis (VKC). Methods-Tears were collected from 30 patients aVected by active mild to moderate VKC before and after therapy with disodium cromoglycate 4% (DSCG) (n=15) or lodoxamide 0.1% (n=15) for 10 days. Tear cytology and ECP measurement were performed, and ocular signs and symptoms evaluated. Results-While statistically significant changes did not occur after DSCG therapy, mean tear ECP increased from 343 (SD 363) µg/l to 571 (777) µg/l due to marked elevation in six eyes. The clinical score in DSCG eyes did not improve. After lodoxamide therapy, both clinical signs and symptoms, and tear ECP levels (560 (756) µg/l to 241 (376) µg/l) decreased significantly (p<0.0001 and p<0.01, respectively). Compared with DSCG treatment, lodoxamide was more eVective in reducing signs and symptoms (p<0.005). ECP levels were significantly correlated with signs, symptoms, corneal involvement, and number of eosinophils in tears (p<0.0001). Conclusions-In patients with VKC, lodoxamide significantly reduced ECP tear levels, and thus, eosinophil activation, and was more eVective than DSCG in reducing clinical signs and symptoms. (Br J Ophthalmol 1997;81:23-26) Vernal keratoconjunctivitis (VKC) is an ocular allergic disease predominantly observed in children and young adults living in warm, southern climates.1 Specific allergens and nonspecific stimuli cause mast cell degranulation and, probably, a lymphocyte mediated response. The high presence of eosinophils in tear fluid and in the conjunctival tissues shows that eosinophils play a major role in the development of this disease.2 Eosinophils, when activated by specific and non-specific stimuli, release granule stored, pharmacologically specific proteins, enzymes, and newly formed mediators. Eosinophil cationic protein (ECP) comprises 30% of the eosinophil granule matrix.3 Its toxic eVect on human corneal epithelial cells has recently been demonstrated in vitro. 4 5 ECP levels in biological fluids correlate with the severity of some allergic diseases and its presence in biological fluids and tissues is now considered a marker for eosinophil activation. 6 We have already reported the usefulness of this marker in monitoring the treatment of VKC and found that ECP levels in tears were strongly correlated to the severity of the disease. 7In this study, tear ECP levels were measured in patients with active VKC treated with two mast cell stabilisers, sodium cromoglycate 4% (DSCG) and lodoxamide tromethamine 0.1%. Lodoxamide has been shown clinically to be more eVective than DSCG in reducing corneal involvement in VKC, a common complication due to toxic proteins released by eosinophils. Materials and methodsThirty patients who had a previous clinical history of VKC and who were aVected by active mild to moderate VKC (mean ...

Multiple specific IgE measurements with single protein allergens using a microarray technique in tear samples are a useful, simple and non-invasive diagnostic tool. ImmunoCAP ISAC detects allergen sensitization at component level and adds important information by defining both cross- and co-sensitization to a large variety of allergen molecules. The presence of specific IgE only in tears of VKC patients reinforces the concept of possible local sensitization.