Tear tryptase in vernal keratoconjunctivitis

Objectives: 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 surfa ce temperature before and after treatment were studied. Patients and Methods: A total of 20 patients, 7 years or older with VKC, we re included in this study. Tear samples for tryptase determination were col lected before and 2 weeks after treatment with 4% disodium cromoglycate eye drops and 0.1% fluorometholone eyedrops. In addition, conjunctival scraping s were obtained for microscopic evaluation, and measurement of the ocular s urface temperature was performed before and 2 weeks after treatment. One pa tient was excluded because the patient did not receive topical treatment. C ontrol tear samples were collected from 20 normal control patients for tryp tase determination. Results: There were 19 patients with VKC (17 males, 2 females). The age ran ge was 7 to 17 years with a mean age of 9 years. The mean number of eosinop hils 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 eosino phils 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 treatmen t was 35.56<degrees>C (range, 34.46 degreesC-36.50 degreesC) and after trea tment was 33.53 degreesC (range, 31.13 degreesC-35.40 degreesC). For the le ft eye, the mean ocular surface temperature before treatment was 35.49 degr eesC (range, 34.86 degreesC-36.16 degreesC) and after treatment was 33.88 d egreesC (range, 32.40 degreesC-35.53 degreesC). The ocular surface temperat ure was found to decrease significantly following treatment (P<.001). The l evels 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). Foll owing treatment with topical 4% disodium cromoglycate and 0.1% fluoromethol one 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 significantl y.