“…Alkaline proteins, such as lactoferrin, are known to rapidly associate with other analytes in solution . Further, interfering factors in tear fluid decrease antibody binding efficiency (i.e., through selective cleaving of the Fab region or steric hindrance of the epitope , ), block the interaction of proteins with surfaces (e.g., ELISA), , and contribute to a myriad of other assay artifacts (e.g., high background signals, blooming effects, matrix effects, and cross-talk between capture and probe antibodies in microwell arrays and immunoassays). , Many of the tear-specific components responsible for these interfering effects have not yet been identified, and given these confounding factors and the high variability of tear film fluid, the reliability of any tear assay is dependent on the volume and type of tear sample, individual donor, and assay employed. Consequently, obtaining quantitative and specific tear protein measurements is difficult .…”