Tear Ferning Test and Pathological Effects on Ocular Surface before and after Topical Cyclosporine in Vernal Keratoconjunctivitis Patients

Abstract

Background Vernal keratoconjunctivitis (VKC) is a rare ocular surface inflammatory disease that affects mainly boys in the first decade of life. Clinical observations show that it generally regresses spontaneously with the onset of puberty, but therapeutic measures must be taken before then to control the course of the disease. PurposeTo evaluate the role of the lacrimal mucous component in VKC patients and compare tear ferning test (TFT) modifications, MUC5AC levels in tears, and density of conjunctival goblet cells to clinical characteristics before and after treatment with cyclosporine A (CY) in eye drops. Methods Forty-seven patients affected by VKC and 30 healthy subjects aged between 3 and 16 years of life were enrolled. All individuals were submitted to complete eye examination and skin prick test (SPT) for the most common allergens. Then, they were subjected to collection of the tears and to impression cytology to evaluate TFT, MUC5AC levels, and conjunctival goblet cell density, before and after treatment with CY in eye drops. Results Comparing the VKC group vs. the control group at baseline, a significant alteration in the degree of the ferns was found, indicating a pathological condition of the lacrimal mucous layer. In addition, an increased number of goblet cells were observed in the patients. The concentration of lacrimal secretory mucins (MUC5AC) did not show significant differences between the 2 groups. Patients treated with CY have reported improvements of some signs and symptoms of disease activity, including TFT, and a tendency of conjunctival goblet cell density to normalise. Conclusions The results obtained demonstrated for the first time a significant alteration of the lacrimal mucin component evaluated in the VKC group, and an improvement of the latter after CY therapy.

<p>Effects of short-term oral vitamin A supplementation on the ocular tear film in patients with dry eye</p>

“…23 The tear ferning (TF) test is also an effective technique for assessing the quality of tears and diagnosing eye dryness. 24,25 The tear volume is most commonly measured using the Schirmer test and/or the phenol red thread (PRT) test. 26 In addition, evaluation of tear evaporation rate is an efficient technique to detect dry eye syndrome.…”

Advances in Dry Eye Disease Examination Techniques

“…Reducing the pressure and humidity or increasing the temperature to speed up the drying speed of the tear results in a smaller crystal morphology and different proportions of the four structural regions in the crystal pattern. In addition to diagnosing dry eye, the tear ferning test can be used to diagnose keratoconjunctivitis and cystic fibrosis disease and for soft contact lens tolerance prediction in clinical practice (58)(59)(60). The tear ferning test has good clinical guiding significance.…”

<p>Eye drop emulsion containing 0.1% cyclosporin (1 mg/mL) for the treatment of severe vernal keratoconjunctivitis: an evidence-based review and place in therapy</p>

“…The follow-up in this study was 12 months, in which the authors analyzed disease severity scores, subjective symptoms and the need for steroid therapy. The follow-up period may be not long enough to allow an adequate evaluation over the course of the treatment because some patients show symptoms only during spring or summer while others present the symptomatology all the year 74,75…”