lactoferrin and Keratoconjunctivitis

Diagnosis of a dry eye is facilitated by prompt recognition of pertinent signs and symptoms and by utilisation of those office and laboratory procedures which help to confirm the diagnosis. Prior knowledge of those systemic diseases associated with keratoconjunctivitis sicca (KCS) alert the practitioner to a possible dry eye state. Conversely, a diagnosis of KCS may prompt recognition of a hitherto unsuspected systemic disease. In this review, I will discuss the signs and symptoms of KCS, its association with various systemic conditions, as well as the tests and procedures that contribute to its diagnosis.

Topics: Adolescent; Adult; Blepharitis; Child; Cornea; Dysautonomia, Familial; Epithelium; Erythema Multiforme; Humans; Keratoconjunctivitis; Lactoferrin; Muramidase; Osmolar Concentration; Pemphigoid, Benign Mucous Membrane; Rose Bengal; Sarcoidosis; Sjogren's Syndrome; Tears

Topical therapy is effective for dry eye, and its prolonged effects should help in maintaining the quality of life of patients with dry eye. We previously reported that the oral administration of rebamipide (Reb), a mucosal protective agent, had a potent therapeutic effect on autoimmune lesions in a murine model of Sjögren's syndrome (SS). However, the effects of topical treatment with Reb eyedrops on the ocular lesions in the murine model of SS are unknown.. Reb eyedrops were administered to the murine model of SS aged 4-8 weeks four times daily. Inflammatory lesions of the extraorbital and intraorbital lacrimal glands and Harderian gland tissues were histologically evaluated. The direct effects of Reb on the lacrimal glands were analyzed using cultured lacrimal gland cells. Tear secretions of Reb-treated mice were significantly increased compared with those of untreated mice. In addition to the therapeutic effect of Reb treatment on keratoconjunctivitis, severe inflammatory lesions of intraorbital lacrimal gland tissues in this model of SS were resolved. The mRNA expression levels of IL-10 and mucin 5Ac in conjunctival tissues from Reb-treated mice was significantly increased compared with those of control mice. Moreover, lactoferrin production from lacrimal gland cells was restored by Reb treatment.. Topical Reb administration had an anti-inflammatory effect on the ocular autoimmune lesions in the murine model of SS and a protective effect on the ocular surfaces.

Topics: Administration, Ophthalmic; Alanine; Animals; Anti-Inflammatory Agents; Cells, Cultured; Disease Models, Animal; Drug Administration Schedule; Female; Gene Expression Regulation; Humans; Interleukin-10; Keratoconjunctivitis; Lacrimal Apparatus; Lactoferrin; Mice; Mucin 5AC; Quinolones; Sjogren's Syndrome

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

An ELISA method is described for measuring the age-related changes of tear lysozyme, lactoferrin, ceruloplasmin, IgA and IgG in normal eyes. The normal levels for these proteins at each age are compared with those from patients with dry and 'questionably dry' eyes, which each have individual profiles, as well as with patients suffering from ocular pemphigoid, chronic non-ulcerative blepharitis and meibomianitis. Results of tear lysozyme assays from patients on various beta-blockers are discussed with the suggested hypothesis that stimulation of beta-receptors per se in the human lacrimal gland is not required for tear protein secretion. The importance of other proteins present in the tear fluid is reviewed.

Topics: Adult; Aged; Aging; Blepharitis; Ceruloplasmin; Eyelid Diseases; Humans; Immunoglobulin A; Immunoglobulin G; Keratoconjunctivitis; Labetalol; Lactoferrin; Middle Aged; Muramidase; Pemphigoid, Bullous; Practolol; Propranolol; Tears; Timolol; Xerophthalmia

A degeneration of the tear gland leads to reduced lysozyme concentrations in the tear fluid. Tear lysozyme concentrations are generally determined by enzymatic methods. Lysozyme determination by radial immunodiffusion has some advantages above the enzymatic assays, and laboratory facilities are not required. The enzymatic properties of lysozyme that favoured its choice as a parameter for tear gland function, influenced to some extent the results of the radial immunodiffusion assay. Therefore we looked among the proteins originating from the lacrimal gland for alternative parameters of tear gland function. In 94 tear samples obtained from a heterogeneous group, ranging from persons with normal lacrimal gland function to severe kerato-conjunctivitis sicca patients, a high degree of correlation was found between lysozyme concentration and that of lactoferrin as well as tear-specific prealbumin. This indicates that the latter two proteins can be used as alternatives for lysozyme in tear gland function tests.

Topics: Electrophoresis, Polyacrylamide Gel; Humans; Immunodiffusion; Keratoconjunctivitis; Lactoferrin; Lactoglobulins; Muramidase; Prealbumin; Serum Albumin; Tears

Topics: Adolescent; Adult; Child; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Keratoconjunctivitis; Lactoferrin; Seasons; Serum Albumin; Tears

Unstimulated basal tears and stimulated tears were collected from normal controls, keratoconjunctivitis sicca (KCS) patients, and contact lens (CL) wearers. Basal tear volume (Periopaper) and reflex tear volume (Schirmer Strip) were measured and tears eluted from their respective strip with a TMED-acetic acid buffer. Lactoferrin and lysozyme concentrations were measured in the eluates. Concentration of lysozyme in basal tears was: 65 +/- 43 mg% in normals; 44 +/- 26 mg% in KCS, and 81 +/- 50 mg% in CL wearers. Concentration of lysozyme in reflex tears was: 160 +/- 73 mg% in normals, 74 +/- 41 mg% in KCS, and 186 +/- 83 mg% in CL wearers. Concentration of lactoferrin in basal tears was 137 +/- 102 mg% in normals, 154 +/- 82 mg% in KCS, and 157 +/- 80 mg% in CL wearers. Concentrations of lactoferrin in reflex tears was: 327 +/- 187 mg% in normals; 171 +/- 69 mg% in KCS, and 302 +/- 160 mg% in CL wearers. The lactoferrin concentration in all tear samples was consistently higher (1.6-3.5 times) than lysozyme. In basal tears, lactoferrin concentrations were not significantly different in the three groups. In reflex tears, however, lactoferrin was significantly lower in KCS than normal or CL wearers. The concentration of lysozyme in both basal and reflex tears was significantly lower in the KCS when compared to normal or CL wearers. Lysozyme and lactoferrin concentrations in both basal and reflex tears were similar in CL wearers and normal controls. The sampling and elution of basal and reflex tears as described appears to be a feasible technique for analysis of lysozyme and lactoferrin concentrations by the electroimmunodiffusion technique and has potential diagnostic value.

Topics: Contact Lenses; Humans; Keratoconjunctivitis; Lactoferrin; Lactoglobulins; Muramidase; Reflex; Tears; Xerophthalmia