“…[4][5][6][7][8][9][10][11][12][13][14][15][16] Altered levels of various cytokines, enzymes, regulatory and growth factors, and diagnostic markers of inflammation and tissue injury have been found in the tears or in the cornea of patients with keratoconus, pointing to the crucial role of the immune system in the pathogenesis of keratoconus. 6,[11][12][13][14] These include proinflammatory cytokines (tumor necrosis factor (TNF), interleukin (IL)-1β, IL-6), inflammatory chemokines (CXCL8, CCL5), inflammatory mediators (IL-12, interferon (IFN)-γ, IL-17), the anti-inflammatory cytokine IL-10, cytokines associated with allergy development (IL-4, IL-13), enzymes and their co-factors associated with tissue remodeling (matrix metalloproteinases (MMPs), tissue inhibitor of metalloproteinase-1 (TIMP-1), cathepsin B). Various growth factors, other enzymes, enzyme inhibitors, cellular proteins which can serve as diagnostic markers in the context of cellular and tissue injury or inflammation were also described, including epidermal growth factor (EGF), vascular endothelial growth factor (VEGF); insulin-growth factors (IGFs), nerve growth factor (NGF), lipocalins, lipophilins, phospholipase A2, cystatins, albumin, type I and type II keratins, lactoferrin, Prolactin-Induced Protein, α-fibrinogen, α1-antitrypsin; apolipoprotein A1 (ApoA1), lysozyme C, zinc-α2-glycoprotein (ZAG), metabolic enzymes (e.g.…”