Tear Eosinophil Cationic Protein Levels in Allergic Keratoconjunctivitis

Byung Su Lim; So Hyang Chung

doi:10.3341/jkos.2014.55.9.1291

Journal List > J Korean Ophthalmol Soc > v.55(9) > 1009773

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Lim and Chung: Tear Eosinophil Cationic Protein Levels in Allergic Keratoconjunctivitis

Original Article

J Korean Ophthalmol Soc 2014;55(9):1291-1297.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.9.1291

Tear Eosinophil Cationic Protein Levels in Allergic Keratoconjunctivitis

Byung Su Lim, MD, So Hyang Chung, MD, PhD

Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea

Address reprint requests to So Hyang Chung, MD, PhD, Department of Ophthalmology, The Catholic University of Korea, Seoul St. Mary's Hospital, #222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea, Tel: 82-2-2258-1188, Fax: 82-2-761-6869, E-mail: chungsh@catholic.ac.kr

Received 14 February 2014 Revised 8 March 2014 Accepted 20 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate tear eosinophil cationic protein (ECP) as a severity marker for atopic keratoconjunctivitis (AKC) and seasonal/perennial allergic conjunctivitis (SAC/PAC).

Methods

Tear ECP levels were measured by chemiluminescent immunometric assay in 7 eyes of 7 patients with AKC, 13 eyes of 13 patients with SAC/PAC, and 10 eyes of 10 healthy control subjects. All AKC and SAC/PAC patients underwent conjunctival injection and papillary formation grading. Tear ECP levels were investigated with reference to the clinical parameters of allergic conjunctivitis (papillary formation and conjunctival injection scoring).

Results

Tear ECP levels in patients with AKC were significantly higher than those in patients with SAC/PAC and in control subjects (p = 0.012 and p = 0.003, respectively). The number of patients with papillary formation scores of 2-3 was significantly higher in the AKC group than in the SAC/PAC group (p = 0.016). The number of patients with conjunctival injection scores of 2-3 did not significantly differ between the AKC and SAC/PAC groups (p = 0.128). All AKC patients obtained papillary formation scores of 2-3, and tear ECP levels in patients with conjunctival injection scores of 2-3 were significantly higher than in patients with scores of 0-1 in the AKC group (p < 0.001). In the SAC/PAC group, tear ECP levels in patients with papillary formation scores of 2-3 were significantly higher than in patients with scores of 0-1 (p = 0.046).

Conclusions

This study suggests that tear ECP was a useful marker to diagnose and assess the severity of disease in patients with AKC as well as SAC/PAC. It would be useful to monitor therapeutic outcome in allergic conjunctivitis.

Keywords: Atopic keratoconjunctivitis, Conjunctival injection score, Papillary formation score, Seasonal/perennial allergic conjunctivitis, Tear eosinophil cationic protein

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Figure 1.

Tear ECP level in allergic conjunctivitis patients. Tear ECP level in AKC patients was significantly higher compared to patients with SAC/PAC or control. Tear ECP level in SAC/PAC patients was significantly higher than the control. ECP = eosinophil cationic protein; AKC = atopic keratoconjunctivitis; SAC = seasonal allergic conjunctivitis; PAC = perennial allergic conjunctivitis.

Figure 2.

Tear ECP level according to the clinical severity of AKC and SAC/PAC patients. (A) Tear ECP level in SAC/PAC patients with papillary scores of 2-3 was significantly higher compared to patients with scores of 0-1. All AKC patients showed papillary scores of 2-3. In scores of 2-3 group, tear ECP levels in AKC patients was significantly higher than those in SAC/PAC patients. (B) Tear ECP level in AKC patients with conjunctival injection scores of 2-3 was significantly higher compared to patients with scores of 0-1. In SAC/PAC patients, tear ECP level did not differ between conjunctival injection scores of 2-3 and 0-1 groups. In scores of 2-3 group, tear ECP levels in AKC patients was significantly higher than those in SAC/PAC patients. ECP = eosinophil cationic protein; AKC = atopic keratoconjunctivitis; SAC = seasonal allergic conjunctivitis; PAC = perennial allergic conjunctivitis.

Table 1.

Scoring conjunctival clinical signs

Score	Papillary formation/Conjunctival injection
0	None
1	Mild
2	Moderate
3	Severe

Table 2.

Tear ECP level in allergic conjunctivitis patients

	AKC	SAC/PAC	Control
Mean ± SD (ug/L)	270.14 ± 150.12	72.90 ± 97.06	1.34 ± 1.40
Median (ug/L)	332	11	1
Range (ug/L)	51.7-462	5.22-258.9	0.1-4.2

ECP = eosinophil cationic protein; AKC = atopic keratoconjunctivitis; SAC = seasonal allergic conjunctivitis; PAC = perennial allergic conjunctivitis.

Table 3.

Papillary formation and conjunctiva injection status grades in allergic conjunctivitis patients

	Papillary formation score		Conjunctival injection score
	0-1	2-3	0-1	2-3
AKC	0	7^*	3	4^†
SAC/PAC	7	6	10	3

AKC = atopic keratoconjunctivitis; SAC = seasonal allergic conjunctivitis; PAC = perennial allergic conjunctivitis.

^* p = 0.016;

^† p = 0.128 by Pearson chi square test respectively.

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