lactoferrin and Keratoconjunctivitis-Sicca

Laboratory tear function tests, such as the lactoferrin and the lysozyme test, reflect the level of tear gland deficiency and are, therefore, very useful for the clinician in the diagnosis of keratoconjunctivitis sicca (KCS). Although these tests do have an excellent discriminatory ability, they should be used in addition to clinical tests, such as the Schirmer-1 test, the tear film break-up time (BUT) and the Rose bengal (Rb) staining test. Schirmer's test, the most commonly used clinical test, measures tear fluid production. The tear film BUT, on the other hand, is the only test which establishes tear film instability. The Rose bengal score is strongly related to secondary damage of the superficial epithelium of the cornea and conjunctiva in patients with KCS. Thus, combining the results of these various tests facilitates the diagnosis of KCS and also the differentiation between Sjögren's KCS and non-Sjögren's KCS.

Topics: Diagnosis, Differential; Humans; Keratoconjunctivitis Sicca; Lacrimal Apparatus; Lactoferrin; Muramidase; Rose Bengal; Tears

We compared measurement of lactoferrin concentration by the LactoCard solid phase ELISA assay with the LactoPlate radial immunodiffusion assay in tears of normal patients and those with keratoconjunctivitis sicca. The LactoCard, a new lactoferrin assay, allows rapid determination of tear lactoferrin concentration in 10-15 min, a notable improvement over the 3 days required of the LactoPlate. There was no statistically significant difference between the accuracy of the two assays in normal patients nor in those patients with a diagnosis of keratoconjunctivitis sicca. Both assays showed a significant decrease in tear lactoferrin concentration in patients with severe keratoconjunctivitis sicca when compared to normal patients. The LactoCard is a rapid and reliable means of measuring tear lactoferrin concentration in a clinical setting.

Topics: Adult; Aged; Aged, 80 and over; Enzyme-Linked Immunosorbent Assay; Evaluation Studies as Topic; Female; Humans; Immunodiffusion; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Tears

This trial was a randomized, double-masked, crossover study during which patients with keratoconjunctivitis sicca underwent 6 weeks of treatment with either cyclosporine 1% ophthalmic ointment or placebo followed by 6 weeks of the alternative treatment. Washout periods using only unpreserved artificial tears preceded both treatment cycles. Twenty-five patients completed the first treatment period, but only eight met entry criteria for period II. Cyclosporine ointment was associated with initial mild to moderate redness, itching, and burning that returned to baseline levels within 1-2 weeks. Rose Bengal results and results of four subjective (patient diary) efficacy parameters favored cyclosporine: foreign body sensation, overall symptoms, hours of symptom control per day, and overall effectiveness. No systemic adverse events or laboratory abnormalities occurred. We conclude that (a) the crossover design is inappropriate for studying this disease; (b) mild to moderate itching, redness, and burning occur initially with cyclosporine administration, although tolerance quickly develops; (c) cyclosporine appears to benefit the ocular surface in keratoconjunctivitis sicca; and (d) further trials in this syndrome are warranted.

Topics: Adult; Aged; Cyclosporine; Double-Blind Method; Female; Humans; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Ointments; Ophthalmic Solutions; Pilot Projects; Placebos; Tears

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Diagnostic Errors; Diagnostic Techniques, Ophthalmological; Female; Humans; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Probability; Reproducibility of Results; Sjogren's Syndrome; Tears

To assess the course of tear gland function of patients with keratoconjunctivitis sicca (KCS) associated with primary (KCS-PSS) or secondary Sjögren's syndrome (KCS-SSS), and of patients with KCS not related to Sjögren's syndrome (KCS-NS).. In 106 patients with dry eye an ophthalmic diagnosis of KCS was made. Subsequent evaluations revealed a diagnosis of KCS-PSS in 31, KCS-SS in 19, and KCS-NS in 56 patients. Follow up assessments have been performed 10-12 years after initial diagnosis.. At baseline and at follow up tear gland function tests were worse in patients with KCS-PSS compared with the other forms of KCS. At follow up in the KCS-SSS patient group the tear gland function variables returned to marginal normal limits. In contrast with expectation, a marked improvement of the tear gland function variables in the KCS-NS patient group was noted.. In KCS-PSS patients tear gland function is characterised by a steady state situation. In KCS-SSS patients the normalisation of tear gland function variables most probably reflects a remission of the underlying disease. In view of the overall improvement in KCS-NS patients the term age related KCS should be avoided.

Topics: Disease Progression; Female; Follow-Up Studies; Humans; Keratoconjunctivitis Sicca; Lacrimal Apparatus; Lactoferrin; Male; Middle Aged; Muramidase; Sjogren's Syndrome; Statistics, Nonparametric; Tears

Results of dry eye tests and ocular symptoms were compared and correlated in patients with primary Sjögren's syndrome (1 degree SS), in patients with connective tissue disease differing from 1 degree SS, and in normal controls. Patients with 1 degree SS had many and pronounced ocular complaints, however, non-diagnostic for the disease. Break-up time and Schirmer-1 test results below 10 mm/5 min both had high sensitivity but low specificity, whereas the reverse was true for Rose-Bengal score and Schirmer-1 test below 5 mm/5 min. Presence of snake-like chromatin in conjunctival imprints and the lactotest on tear fluid did not qualify as alternative tests since they had very low specificity and were less sensitive than the Schirmer-1 test and break-up time. Cornea sensitivity was not found to be an appropriate test at all. In 21% of eyes the presence of keratoconjunctivitis sicca changed from one consultation to the next in patients with 1 degree SS. Examination for keratoconjunctivitis sicca should therefore be repeated in test negative cases where symptoms indicate 1 degree SS.

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Diagnostic Tests, Routine; Female; Humans; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Prevalence; Sensitivity and Specificity; Sjogren's Syndrome; Surveys and Questionnaires; Tears

We studied the relationship between the severity of ocular surface damage and the level of tear lactoferrin in primary and secondary Sjögren's syndrome and keratoconjunctivitis sicca not associated with Sjögren's syndrome. A significant negative correlation was found between Rose Bengal staining score and level of tear lactoferrin in all three groups. Analysis of covariance disclosed no significant differences in regression lines for Rose Bengal staining score vs tear lactoferrin level among the three groups. The three regression lines appeared to be identical to each other. These findings indicate that the severity of ocular surface damage due to dry eye largely depends on the tear secretory function of the lacrimal gland, and that the function of the lacrimal gland can be evaluated by determination of level of tear lactoferrin using the same standards regardless of differences in pathogenesis of underlying diseases.

Topics: Adolescent; Adult; Aged; Analysis of Variance; Dry Eye Syndromes; Eye Proteins; Female; Humans; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Rose Bengal; Sjogren's Syndrome; Tears

The authors found the tear lactoferrin content in normal Chinese adults to be 1.46 +/- 0.32 mg/ml (mean +/- 1 SD), and the mean counting rate of its unsaturated binding power of iron 63,660 +/- 17,010/min/ml (mean +/- 1 SD), with very significant positive correlation between the two, irrespective of sex or eye distinction. Tear lactoferrin began to decrease after 40 years of age, and remarkably so after 70. The authors deemed the measurement of tear lactoferrin a reliable and sensitive marker for the diagnosis of keratoconjunctivitis sicca. In patients with bacterial corneal ulcer and acute catarrhal conjunctivitis, the lactoferrin content in tears was normal, in chronic catarrhal conjunctivitis, the unsaturated binding power of iron was decreased.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Corneal Ulcer; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Lactoglobulins; Male; Middle Aged; Reference Values; Tears

Keratoconjunctivitis sicca is a commonly encountered disease with decreased lacrimal gland activity. There are several tests to determine the lacrimal gland function, but all have limitations in accuracy, sensitivity or technical difficulty. At present, there is no reliable objective test to render a firm diagnosis of dry eye. Lactoferrin is one of the major proteins secreted by the lacrimal gland. Its concentration was found to correlate well to lacrimal gland activity. In this study we tried to evaluate the diagnostic value of lactoferrin measurement in comparison with other tests for keratoconjunctivitis sicca. Tests including the measurement of tear lactoferrin, Schirmer's-1 test, Schirmer's basal test, tear film break-up time, and rose bengal stain of the cornea were done on 60 healthy eyes and 56 eyes with keratoconjunctivitis sicca. The lactoferrin level was measured by a commercially available "Lactoplate" (Eagle Vision, U.S.A.). It is a plate containing gel loaded with rabbit anti-human-lactoferrin antiserum. Tear-moistened filter paper discs containing lactoferrin were placed on the gel. The lactoferrin concentration could be determined by measuring the concentric ring of precipitate after 72 hours incubation at room temperature. The average concentration of lactoferrin was 1.9 +/- 0.51 mg/ml in the normal group and 1.4 +/- 0.93 mg/ml in the keratoconjunctivitis sicca group. They were significantly different from each other (t-test: p less than 0.05). The results of the other 4 tests also showed a significant difference between the normal and keratoconjunctivitis sicca group, but the lactoferrin measurement had the highest specificity among these 5 tests. Because of the technical simplicity of measurement and its high specificity, lactoferrin measurement could be a valuable tool for the early and accurate diagnosis of keratoconjunctivitis sicca.

Topics: Adult; Aged; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Lactoglobulins; Male; Middle Aged; Tears

We compared the relative value of the tear film breakup time, Schirmer test, lactoferrin immunologic assay and rose bengal staining in 156 patients with varying severity of symptoms characteristic of keratoconjunctivitis sicca and in 39 controls. Statistical analysis showed that in patients with minimal ocular irritation the Schirmer test in combination with the lactoferrin immunologic assay provided an optimal balance between high test sensitivity and low false-positive rates. In patients with moderate to severe ocular burning, foreign body sensation, or pain but with no systemic symptoms of dry mouth or arthritis, and in patients with both ocular and systemic complaints, the lactoferrin assay alone provided statistically significant results. Tear film breakup time and staining with rose bengal were not useful and the Schirmer test had limited value in measuring the rate of tear secretion in these patients.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Immunodiffusion; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Ophthalmology; Rose Bengal; Sensitivity and Specificity; Staining and Labeling; Tears

In a group of patients with keratoconjunctivitis sicca (KCS) associated with Sjögren's syndrome (SJ) a significant decrease in tear fluid lactoferrin concentration and tear film break-up time was demonstrated in comparison with a matched group in which KCS was not associated with any systemic disease. The Schirmer values were also lower in the SJ of patients and these differences almost reached statistical significance. None of these parameters in itself appeared to be of any clinical value to differentiate between KCS that was or was not associated with SJ. The combination of the tear fluid lactoferrin concentration, the Schirmer I test values and the tear film break-up time, however, provide a basis for differential diagnosis that is clinically of some value.

Topics: Adult; Aged; Aged, 80 and over; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Middle Aged; Osmolar Concentration; Proteins; Sjogren's Syndrome; Statistics as Topic; Tears

Tear fluid lysozyme concentration, measured by means of the agar diffusion assay, and lactoferrin concentration, measured with radial immunodiffusion using the Lactoplate test, were determined in 112 persons in routine clinical practice. About one third of these persons had symptoms and signs compatible with keratoconjunctivitis sicca. A good correlation was found between these tear proteins in the tear fluid in persons with normal tear function and in those with a tear function disorder. In 8%, false-positive and false-negative results were obtained, but the difference in associated values of lysozyme and lactoferrin concentration was small.

Topics: Adolescent; Adult; Aged; False Negative Reactions; False Positive Reactions; Female; Humans; Immunodiffusion; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Lactoglobulins; Male; Middle Aged; Muramidase; Radioimmunoassay; Tears

Topics: Adult; Aged; Aged, 80 and over; Albumins; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Muramidase; Osmolar Concentration; Tears

The concentrations of tear lysozyme, lactoferrin, ceruloplasmin, IgA, and IgG have been estimated in patients with dry eyes at the same time as semiquantitative bacterial culture was performed of the conjunctivae and lids. Staphylococcal isolations were quantified and biotyped. There was no increased conjunctival colonisation by any particular biotype of Staphylococcus aureus or Staph. epidermidis, and similar numbers of conjunctivae were sterile as in controls (33%); neither were any pathogens such as pneumococci or haemophili isolated. We consider that the conjunctiva of the dry eye, without the lacrimal secretion components of lysozyme and lactoferrin, has an alternative protective antibacterial mechanism which is derived from serum proteins via chronically inflamed vessels.

Topics: Adult; Aged; Ceruloplasmin; Conjunctiva; Eyelids; Humans; Immunoglobulin A; Immunoglobulin G; Keratoconjunctivitis Sicca; Lactoferrin; Middle Aged; Muramidase; Proteins; Staphylococcus aureus; Staphylococcus epidermidis; Tears; Xerophthalmia