Dry Eye in Vernal Keratoconjunctivitis: A Cross-Sectional Comparative Study

Edoardo Villani, Marika Dello Strologo, Francesco Pichi, Saverio V Luccarelli, Stefano De Cillà, Massimiliano Serafino, Paolo Nucci, Edoardo Villani, Marika Dello Strologo, Francesco Pichi, Saverio V Luccarelli, Stefano De Cillà, Massimiliano Serafino, Paolo Nucci

Abstract

The purpose of this comparative cross-sectional study was to investigate the use of standardized clinical tests for dry eye in pediatric patients with active and quiet vernal keratoconjunctivitis (VKC) and to compare them with healthy children.We recruited 35 active VKC, 35 inactive VKC, and 70 age-matched control healthy subjects. Each child underwent a complete eye examination, including visual analog scale symptoms assessment, biomicroscopy, fluorescein break-up time (BUT), corneal fluorescein and conjunctival lissamine green staining, corneal esthesiometry, Schirmer test with anesthetic, and meibomian glands inspection and expression.Active VKC patients showed significantly increased symptoms and signs of ocular surface disease, compared with the other 2 groups. Inactive VKC patients, compared with control subjects, showed increased photophobia (P < 0.05; Mann-Whitney U test), conjunctival lissamine green staining and Schirmer test values, and reduced BUT and corneal sensitivity [P < 0.05 by analysis of variance (ANOVA) least significant difference posthoc test for BUT and Schirmer; P < 0.001 by Mann-Whitney U test for lissamine green staining and corneal sensitivity].Our results confirm the association between VKC and short-BUT dry eye. This syndrome seems to affect the ocular surface in quiescent phases too, determining abnormalities in tear film stability, epithelial cells integrity, and corneal nerves function. The very long-term consequences of this perennial mechanism of ocular surface damage have not been fully understood yet.

Conflict of interest statement

Conflict of interests: none for all authors.

References

    1. Alves M, Dias AC, Rocha EM. Dry eye in childhood: epidemiological and clinical aspects. Ocul Surf 2008; 6:44–51.
    1. Fujishima H, Toda I, Shimazaki J, et al. Allergic conjunctivitis and dry eye. Br J Ophthalmol 1996; 80:994–997.
    1. Toda I, Shimazaki J, Tsubota K. Dry eye with only decreased tear break-up time is sometimes associated with allergic conjunctivitis. Ophthalmology 1995; 102:302–309.
    1. Dogru M, Okada N, Asano-Kato N, et al. Atopic ocular surface disease: implications on tear function and ocular surface mucins. Cornea 2005; 24 (8 Suppl):S18–S23.
    1. Hu Y, Matsumoto Y, Dogru M, et al. The differences of tear function and ocular surface findings in patients with atopic keratoconjunctivitis and vernal keratoconjunctivitis. Allergy 2007; 62:917–925.
    1. Hom MM, Nguyen AL, Bielory L. Allergic conjunctivitis and dry eye syndrome. Ann Allergy Asthma Immunol 2012; 108:163–166.
    1. Bielory L. Ocular allergy and dry eye syndrome. Curr Opin Allergy Clin Immunol 2004; 4:421–424.
    1. Onguchi T, Dogru M, Okada N, et al. The impact of the onset time of atopic keratoconjunctivitis on the tear function and ocular surface findings. Am J Ophthalmol 2006; 141:569–571.
    1. Vichyanond P, Pacharn P, Pleyer U, et al. Vernal keratoconjunctivitis: a severe allergic eye disease with remodeling changes. Pediatr Allergy Immunol 2014; 25:314–322.
    1. Bonini S, Lambiase A, Marchi S, et al. Vernal keratoconjunctivitis revisited: a case series of 195 patients with long-term followup. Ophthalmology 2000; 107:1157–1163.
    1. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea 2003; 22:640–650.
    1. Shimazaki J, Sakata M, Tsubota K. Ocular surface changes and discomfort in patients with meibomian gland dysfunction. Arch Ophthalmol 1995; 113:1266–1270.
    1. Arita R, Itoh K, Maeda S, et al. Meibomian gland duct distortion in patients with perennial allergic conjunctivitis. Cornea 2010; 29:858–860.
    1. Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007; 5:108–152.
    1. Dogru M, Gunay M, Celik G, Aktas A. Evaluation of the tear film instability in children with allergic diseases. Cutan Ocul Toxicol. 2015 Feb 19:1–4. [Epub ahead of print].
    1. Dogru M, Matsumoto Y, Okada N, et al. Alterations of the ocular surface epithelial MUC16 and goblet cell MUC5AC in patients with atopic keratoconjunctivitis. Allergy 2008; 63:1324–1334.
    1. Sacchetti M, Lambiase A, Mantelli F, et al. Tailored approach to the treatment of vernal keratoconjunctivitis. Ophthalmology 2010; 117:1294–1299.
    1. Lambiase A, Minchiotti S, Leonardi A, et al. Prospective, multicenter demographic and epidemiological study on vernal keratoconjunctivitis: a glimpse of ocular surface in Italian population. Ophthalmic Epidemiol 2009; 16:38–41.
    1. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea 2004; 23:762–770.
    1. Han SB, Yang HK, Hyon JY, et al. Children with dry eye type conditions may report less severe symptoms than adult patients. Graefes Arch Clin Exp Ophthalmol 2013; 251:791–796.
    1. Arita R, Itoh K, Maeda S, et al. Association of contact lens-related allergic conjunctivitis with changes in the morphology of meibomian glands. Jpn J Ophthalmol 2012; 56:14–19.
    1. Leonardi A, Lazzarini D, Bortolotti M, et al. Corneal confocal microscopy in patients with vernal keratoconjunctivitis. Ophthalmology 2012; 119:509–515.
    1. Villani E, Mantelli F, Nucci P. In-vivo confocal microscopy of the ocular surface: ocular allergy and dry eye. Curr Opin Allergy Clin Immunol 2013; 13:569–576.
    1. Nebbioso M, Zicari AM, Lollobrigida V, et al. Assessment of corneal alterations by confocal microscopy in vernal keratoconjunctivitis. Semin Ophthalmol 2015; 30:40–43.
    1. You J, Willcox MD, Madigan MC, et al. Tear fluid protein biomarkers. Adv Clin Chem 2013; 62:151–196.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere