Anti-inflammatory and antiallergic effects of ketorolac tromethamine in the conjunctival provocation model

Aim-To study the effect of the topical anti-inflammatory drug, ketorolac, o n (1) the clinical allergic reaction induced by the conjunctival provocatio n test (CPT); (2) the release of tryptase in tears; and (3) the expression of adhesion molecules on the conjunctival epithelium. Methods-10 allergic but non-active patients were challenged in both eyes wi th increasing doses of specific allergen to obtain a positive bilateral rea ction and rechallenged, after 1 week, to confirm the allergic threshold dos e response. After 2 weeks, a third CPT was then performed bilaterally 30 mi nutes after topical application of ketorolac in one eye and placebo in the contralateral eye in a double blind fashion. Clinical symptoms and signs we re registered 5, 10, 15, and 20 minutes after challenge. The following obje ctive tests were performed: tear tryptase measurement; tear cytology; and c onjunctival impression cytology for immunohistochemical expression of ICAM- 1 on epithelial cells. Results-Compared with placebo, ketorolac significantly reduced the total cl inical score and the itching score in the 20 minutes after challenge (p<0.0 005). Tear levels of tryptase were significantly reduced in the ketorolac p retreated eyes compared with placebo (p<0.03). Eosinophils, neutrophils, an d lymphocytes in tear cytology were significantly lower in ketorolac treate d eyes compared with placebo. A significant difference in the epithelial ex pression of ICAM-1 was observed between placebo and ketorolac treated eyes (p<0.05). Conclusion-Ketorolac proved to be effective in reducing mast cell degranula tion, as indicated by significantly decreased tryptase tear levels, as well as the clinical and cytological allergic reaction.