IMMUNOGLOBULIN E SCREENING OF SERUM AND LACRIMAL FLUID � A NEW DIMENSION IN THE MANAGEMENT OF CHRONIC CONJUNCTIVITIS

Abstract

Purpose: The purpose of present study is to differentiate between allergic and environment related chronic conjunctivitis on the basis of the measurement of Immunoglobulin E levels in tears and serum. Patients and Methods: Forty specimens of tear and serum from drivers were sent for Immunoglobulin E assay. Samples were divided clinically into two   categories. Group A included twenty four samples (60%) who were clinically chronic conjunctivitis (chronic conjunctivitis is defined here as conjunctival inflammation of period greater than a year, remissions and relapses, with no obvious cause/ophthalmic disease and patient on or off topical treatment) and group B included sixteen samples (40%), of clinically normal (normal having no ocular symptoms) (control). Length of service as driver, hours of daytime driving, primary ocular symptom, history of atopy or allergy, tear film break up time (BUT) were emphasized at history and ophthalmic examination. None of the subjects had clinically obvious cause of conjunctivitis. The group-A (patients) were randomly treated with fluoromethalone and artificial tears. The patients were required   to record the subjective   improvement. Results: Tear Immunoglobulin E values were normal (1-2ku/L) in both A and B groups. Serum Immunoglobulin E was elevated significantly in twenty samples (84%) in group A (clinically chronic conjunctivitis) whereas, it was elevated in six samples (38%) in group B (clinically normal group). Serum Immunoglobulin E levels were normal in 16% and 62% of group A and B respectively. The recovery was significant with fluoromethalone use at 4 weeks as compared to that of artificial tears but at 8 weeks and 12 weeks, there was no significant difference between artificial tears group and fluoromethalone group.          Conclusion: Serum Immunoglobulin E and tear Immunoglobulin E levels can be used to investigate the cases of chronic conjunctivitis as normalcy of tear Immunoglobulin E reasonably excludes local allergy. This enables the clinician to resort to tear replacement therapy rather than prescribing steroids with accompanying side effects. However, there is no correlation of serum Immunoglobulin E with tear Immunoglobulin E.