Development and testing of the quality of life in children with vernal keratoconjunctivitis questionnaire.

PURPOSE: To develop and validate a questionnaire that measures health-related quality of life (HRQoL) in children with vernal keratoconjunctivitis (VKC). DESIGN: Prospective, observational case series. METHODS: An initial list of 42 items was developed and administered to 30 children with active VKC (six girls and 24 boys; mean age, nine +/- two years). The 30 most significant items were selected and converted into questions on a three-step scale for validation in 41 children with active VKC (eight girls and 33 boys; mean age, 9.5 +/- 2.1 years). Twenty-two children also completed the generic KINDL questionnaire. Clinical signs were evaluated and scored and total sign scores (TSSs) were calculated. Validation was performed by factorial analysis and Pearson correlation. Internal consistency was computed by the Chronbach alpha on the extracted factors. RESULTS: Factorial analysis extracted two factors with good internal consistency: symptoms (12 items; alpha = 0.89) and daily activities (four items; alpha = 0.77). Correlations of Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) scores to KINDL scores were in the expected direction. Most patients reported itching (93%), burning (90%), redness (90%), the need to use eye drops (90%), tearing (83%), and photophobia (80%). The children's greatest concerns were limitations on going to the pool (71%), playing sports (58%), and meeting friends (58%). QUICK symptom scores were correlated significantly to conjunctival hyperemia (P < .001), secretion (P = .042), chemosis (P = .012), superficial punctate keratopathy (P < .001), and TSS (P = .010). CONCLUSIONS: The QUICK questionnaire is a new, simple instrument to measure HRQoL in children with severe allergic conjunctivitis. This test is effective for the global evaluation of the impact of VKC on children's daily lives.

Hyperosmolar conjunctival provocation for the evaluation of nonspecific hyperreactivity in healthy patients and patients with allergy.

BACKGROUND: Tissue hyperreactivity of target organs to nonspecific stimuli is known to be an important factor in influencing the clinical picture of allergic disease. OBJECTIVE: To identify the sensitivity and specificity of a hyperosmolar conjunctival provocation test in predicting conjunctival hyperreactivity and to relate this reactivity to the presence of ocular discomfort in subjects with and without allergy. METHODS: In 50 healthy patients and 19 patients with allergic conjunctivitis during remission phase, symptoms of ocular discomfort triggered by nonspecific stimuli were identified and graded with a discomfort score. Subjects were then challenged with a glucose solution at increasing concentrations (from 10% to 50%). The glucose concentration that elicited 2+ conjunctival hyperemia was considered the provoking dose. The response to this hyperosmolar provocation in subjects with ocular discomfort was compared with that of asymptomatic subjects. Sensitivity and specificity of the test in predicting conjunctival hyperreactivity were analyzed. RESULTS: Six of 50 healthy subjects and 12 of 19 subjects with allergy complained of ocular discomfort after exposure to nonspecific stimuli. The hyperosmolar provocation test discriminated between subjects with and without ocular discomfort (mean provoking dose: 39.5% +/- 5% and 47.5% +/- 5% glucose, respectively; P < .001). Forty percent glucose was the optimal threshold dose that demonstrated the highest sensitivity and specificity for prediction of conjunctival hyperreactivity. Discomfort scores were significantly related to provoking dose values (P < .05). CONCLUSION: This study provides a standardized procedure to detect nonspecific conjunctival hyperreactivity independent of underlying atopy. CLINICAL IMPLICATIONS: Hyperosmolar provocation test may be useful for identifying conjunctival hyperreactivity in subjects with and without allergy with a history of ocular discomfort.

Toll-like receptors and the eye.

PURPOSE OF REVIEW: This review will describe the structure, expression/distribution and functional activity of Toll-like receptors, in particular in the ocular structures. It will also discuss innate and adaptive immune responses, by exploring the possible modulation/regulation of innate and adaptive immunity by Toll-like receptors, in view of recent findings observed in the ocular surface. RECENT FINDINGS: Current knowledge indicates that Toll-like receptors represent essential elements in host defence against pathogens, a prerequisite to the induction of adaptive immune responses. The expression/distribution of Toll-like receptors in the healthy eye highlights the possible function of Toll-like receptors in both innate and adaptive responses during pathological conditions of the ocular surface. SUMMARY: Recent findings have greatly increased the knowledge of the possible role of Toll-like receptors in innate and adaptive immune responses. Toll-like receptors seem to play different roles in a wide range of activities of the immune system, and might represent an exclusive link between innate and adaptive responses under pathological conditions. Recent studies in ophthalmology have highlighted the role of Toll-like receptors in infections (keratitis) as well as in allergic states of the ocular surface. This review thus describes the relationship between Toll-like receptors and the main immune/structural cells taking part in inflammatory disorders. Understanding the complex mechanisms underlying Toll-like receptor localization and function will provide additional data that might help devise novel therapeutic approaches involving Toll-like receptors and their agonists, in an attempt to modulate the biased immune system.