Background: Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent worldwide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC. Objective: To determine level of immunoglobulin E (IgE) in the tear ¿ lm of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). Materials and methods: Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro-capillary glass tube method and tear IgE levels were measured using an enzyme -linked immunosorbent assay (ELISA). Results: There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically signi¿ cant (p=0.16). No statistically signi¿ cant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically signi¿ cant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any signi¿ cant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically signi¿ cant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically signi¿ cant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p= 0.72). Conclusion: There was high concentration of tear IgE level observed in VKC.Key words: Vernal keratoconjunctivitis, Tear¿ lm, IgE level, Type I hypersensitivity reaction, Type IV hupersensitivity reaction. T ype I hypersensitivity reaction which is IgEdependent and type IV hypersensitivity reaction have been implicated for the pathogenesis of Vernal Keratoconjunctivitis (VKC) 1,2,3 . However, IgEdependent hypersensitivity reaction has been observed as the important factor for the pathogenesis. IgE sensitizes cells like mast cells and basophils, resulting in degranulation and release of vasoactive amines which are responsible for clinical manifestations of VKC. In VKC, tear IgE level is signi¿ cantly high. In a study by Nomura K and Takamura E, tear IgE concentration was increased signi¿ cantly in the VKC (322.2 +/-45ng/ ml = 134.25 IU/ml), SAC (194.7+/-21.7 ng/ml) and PAC (134.8+/-23.1 ng/ml) than in controls (52.1+/-9.7 ng/ml=21.71 IU/ml) (p=0.1) 4 .In another study by Mathea R Allansmith, Hahn GS and Simon MA, the mean tear IgE concentration was high i...