Background: Seasonal allergic conjunctivitis can manifest itself through tear film instability and symptoms of eye discomfort during the pollen season. This study investigated whether seasonal allergic inflammation defines tear film instability outside the season. Methods: Twenty-three control subjects and 13 ragweed-allergic patients were involved (21 female, 15 male; mean age 26.6 ± 5.4 years). Outside the pollen season, subjective ocular symptoms, non-invasive tear film break-up time, lower tear meniscus height and the tear lipid layer’s interference pattern grade were recorded. C3a complement activation level was also measured in collected tear samples. Results: Non-invasive tear film break-up time, lower tear meniscus height, C3a complement activation level and the incidence of the different grades of tear lipid pattern did not differ significantly in the two examined groups (p ≧ 0.223). The mean eye symptom score outside the season was greater in the allergic group, but the difference was not significant (p = 0.062). The C3a complement activation level showed a significant and inverse correlation with the lipid layer grade (r = –0.343, p = 0.017). Among the participants with thinner tear lipid layers, the complement activation in the tear samples was higher than among those patients with normal tear lipid layers. Conclusion: Seasonal allergic inflammation did not cause permanent tear film instability and eye symptoms were not observed outside the pollen season.

1.
Lemp MA, Baudouin C, Baum J, Dogru M, Foulks GN, Kinoshita S, Laibson P, McCulley J, Murube J, Pflugfelder SC, Rolando M, Toda I: The definition and classification of dry eye disease: report of definition and classification subcommittee of international dry eye workshop. Ocul Surf 2007;5:75–92.
2.
Martin NF, Rubinfeld RS, Malley JD, Manzitti V: Giant papillary conjunctivitis and Meibomian gland dysfunction blepharitis. CLAO J 1992;18:165–169.
3.
Bonini S, Coassin M, Aronni S, Lambiase A: Vernal keratoconjunctivitis. Eye 2004;18:345–351.
4.
Suzuki S, Goto E, Dogru M, Asano-Kato N, Matsumoto Y, Hara Y, Fujishima H, Tsubota K: Tear film lipid layer alterations in allergic conjunctivitis. Cornea 2006;25:277–280.
5.
Toda I, Shimazaki J, Tsubota K: Dry eye with only decreased tear break-up time is sometimes associated with allergic conjunctivitis. Ophthalmology 1995;102:302–309.
6.
Dogru M, Okada N, Asana-Kato N, Tanaka M, Igarashi A, Takano Y, Fukagawa K, Shizamaki J, Tsubota K, Fujishima H: Atopic ocular surface: disease implications on tear function and ocular surface mucins. Cornea 2005;24:S18–S23.
7.
Bonini S, Bonini S, Berruto A, Tomassini M, Carlesimo S, Bucci MG, Balsano F: Conjunctival provocation test as a model for the study of allergy and inflammation in humans. Int Arch Allergy Appl Immunol 1989;88:144–148.
8.
Ballow M, Donshik PC, Mendelson L: Complement proteins and C3 anaphylatoxin in the tears of patients with conjunctivitis. J Allergy Clin Immunol 1985;76:473–476.
9.
Hartman CT Jr, Glovsky MM: Complement activation requirements for histamine release from human leukocytes: influence of purified C3ahu and C5ahu on histamine release. Int Arch Allergy Appl Immunol 1981;66:274–281.
10.
Ricca V, Landi M, Ferrero P, Bairo A, Tazzer C, Canonica GW, Ciprandi G: Minimal persistent inflammation is also present in patients with seasonal allergic rhinitis. J Allergy Clin Immunol 1999;104:54–57.
11.
Ciprandi G, Buscaglia S, Pesce G, Prozanto C, Ricca V, Parmiani S, Bagnasco M, Canonica GW: Minimal persistent inflammation is present at mucosal level in patients with asymptomatic rhinitis and mite allergy. J Allergy Clin Immunol 1995;96:971–979.
12.
Guillon JP: Non-invasive tearscope plus routine for contact lens fitting. Cont Lens Anterior Eye 1998;21:S31–S40.
13.
Introduction and guided tour to Tearscope plus. V2.6. Windsor, Keeler Ltd., 1998.
14.
Johnson ME, Murphy PJ: Temporal changes in the tear menisci following a blink. Exp Eye Res 2006;83:517–525.
15.
Lemp MA, Baudouin C, Baum J, Dogru M, Foulks GN, Kinoshita S, Laibson P, McCulley J, Murube J, Pflugfelder SC, Rolando M, Toda I: methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf 2007;5:108–123.
16.
Merayo-Lloves J, Calonge M, Foster CS: Experimental model of allergic conjunctivitis to ragweed on guinea pig. Curr Eye Res 1995;14:487–494.
17.
Kunert KS, Keane-Myers AM, Spurr-Michaud S, Tisdale AS, Gipson IK: Alteration in goblet cell numbers and mucin gene expression in a mouse model of allergic conjunctivitis. Invest Ophthalmol Vis Sci 2001;42:2483–2489.
18.
Fujishima H, Toda I, Shimazaki J, Tsubota K: Allergic conjunctivitis and dry eye. Br J Ophthalmol 1996;80:994–997.
19.
Hughes JL, Lackie PM, Wilson SJ, Church MK, McGill JI: Reduced structural proteins in conjunctival epithelium in allergic eye disease. Allergy 2006;61:1268–1274.
20.
Anderson DF, Macleod JDA, Baddeley SM, Bacon AS, McGill JI, Holgate ST, Roche WR: Seasonal allergic conjunctivitis is accompanied by increased mast cell numbers in the absence of leucocyte infiltration. Clin Exp Allergy 1997;27:1060–1066.
21.
Mainstone JC, Bruce AS, Golding TR: Tear meniscus measurement in the diagnosis of dry eye. Curr Eye Res 1996;15:653–661.
22.
Yokoi N, Komuro A: Non-invasive methods of assessing the tear film. Exp Eye Res 2004;78:399–407.
23.
Wang J, Palakuru JR, Aquavella JV: Correlations among upper and lower tear menisci, noninvasive tear break-up time, and Schirmer test. Am J Ophthalmol 2008;145:795–800.
24.
Guillon M, Styles E, Guillon JP, Maïssa C: Preocular tear film characteristics of nonwearers and soft contact lens wearers. Optom Vis Sci 1997;74:273–279.
25.
Purslow C, Wolffsohn J: The relation between physical properties of the anterior eye and ocular surface temperature. Optom Vis Sci 2007;84:197–201.
26.
Uchida A, Uchino M, Goto E, Hosaka E, Kasuya Y, Fukagawa F, Dogru M, OgawaY, Tsubota K: Noninvasive interference tear meniscometry in dry eye patients with Sjögren syndrome. Am J Ophthalmol 2007;144:232–237.
27.
Patel S, Wallace I: Tear meniscus height, lower punctum lacrimale, and the tear lipid layer in normal aging. Optom Vis Sci 2006;83:731–739.
28.
Craig JP, Tomlinson A: Importance of the lipid layer in human tear film stability and evaporation. Optom Vis Sci 1997;74:8–13.
29.
Yokoi N, Takehisa Y, Kinoshita S: Correlation of tear lipid layer interference patterns with the diagnosis and severity of dry eye. Am J Ophthalmol 1996;122:818–824.
30.
Sarma VJ, Huber-Lang M, Ward PA: Complement in lung disease. Autoimmunity 2006;39:387–394.
31.
Willcox MD, Morris CA, Thakur A, Sack RA, Wickson J, Boey W: Complement and complement regulatory proteins in human tears. Invest Ophthalmol Vis Sci 1997;38: 1–8.
32.
Mezei G, Varga L, Veres A, Füst G, Cserháti E: Complement activation in the nasal mucosa following nasal ragweed-allergen challenge. Pediatr Allergy Immunol 2001;12:201–207.
33.
Versura P, Fresina M, Campos EC: Ocular surface changes over the menstrual cycle in women with and without dry eye. Gyn Endocrinol 2007;23:385–390.
34.
Burbach GJ, Heinzerling LM, Edenharter G, Bachert C, Bindslev-Jensen C, Bonini S, Bousquet J, Bousquet-Rouanet L, Bousquet PJ, Bresciani M, Bruno A, Canonica GW, Darsow U, Demoly P, Durham S, Fokkens WJ, Giavi S, Gjomarkaj M, Gramiccioni C, Haahtela T, Kowalski ML, Magyar P, Muraközi G, Orosz M, Papadopoulos NG, Röhnelt C, Stingl G, Todo-Bom A, von Mutius E, Wiesner A, Wöhrl S, Zuberbier T: GA(2)LEN skin test study II: clinical relevance of inhalant allergen sensitizations in Europe. Allergy. 2009;64:1507–1515.
35.
Veres A, Kosina-Hagyó K, Németh J: Unchanged goblet cell counts and epithelial metaplasia in seasonal allergic conjunctivitis outside the pollen season. 6th International Conference on the Tear Film and Ocular Surface: Basic Science and Clinical Relevance, Florence, Italy, 2010.
36.
Montoro J, Sastre J, Jáuregui I, Bartra J, Dávila I, del Cuvillo A, Ferrer M, Mullol J, Valero A: Allergic rhinitis: continuous or on demand antihistamine therapy? J Invest Allegol Clin Immunol 2007;17:21–27.
37.
Canonica GW, Compalati E: Minimal persistent inflammation in allergic rhinitis: implications for current treatment strategies. Clin Exp Immunol 2009;158:260–271.
38.
Sacchetti M, Lambiase A, Aronni S, Griggi T, Ribatti V, Bonini S, Bonini S: Hyperosmolar conjunctival provocation for the evaluation of nonspecific hyperreactivity in healthy patients and patients with allergy. J Allergy Clin Immunol 2006;118:872–877.
39.
Ciprandi G, Buscaglia S, Pesce G, Lotti R, Rolando M, Bagnasco M, Canonica GW: Effects of conjunctival hyperosmolar challenge in allergic subjects and normal controls. Int Arch Allergy Immunol 1994;104:92–96.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.