Abstract

Volume.116 Number.5

Original article : Clinical science

Evaluation of the Efficacy of Subjective Symptoms, Objective Findings, and of a Total Tear IgE Detection Kit in Diagnosis of Allergic Conjunctival Diseases
Jun Shoji1, Eiichi Uchio2, Nobuyuki Ebihara3, Yuichi Ohashi4, Shigeaki Ohno5, Shigeki Okamoto6, Naoki Kumagai7, Yoshiyuki Satake8, Kenichi Namba9, Kazumi Fukagawa10,11, Atsuki Fukushima12, Hiroshi Fujishima13, Etsuko Takamura14
1 Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine
2 Department of Ophthalmology, Fukuoka University, School of Medicine
3 Department of Ophthalmology, Juntendo University School of Medicine
4 Department of Ophthalmology, Ehime University, School of Medicine
5 Department of Ocular Inflammation and Immunology, Hokkaido University Graduate School of Medicine
6 Okamoto Eye Clinic
7 Kumagai Eye Clinic
8 Department of Ophthalmology, Tokyo Dental College, Ichikawa General Hospital
9 Department of Ophthalmology, Hokkaido University Graduate School of Medicine
10 Department of Ophthalmology, Keio University School of Medicine
11 Ryogoku Eye Clinic
12 Department of Ophthalmology, Kochi Medical School
13 Department of Ophthalmology, Tsurumi University Dental Hospital
14 Department of Ophthalmology, Tokyo Women's Medical University, School of Medicine

Purpose: To evaluate the efficacy of subjective symptoms, objective findings, and of a total tear IgE test kit in the diagnosis of allergic conjunctival diseases (ACD).
Subjects and methods: The subjects were 223 patients with ACD, diagnosed according to the clinical practice guidelines for allergic conjunctival diseases in 28 medical facilities in Japan. The ACD patients were divided into the following five groups: 84 patients with seasonal allergic conjunctivitis (SAC), 52 patients with perennial allergic conjunctivitis (PAC), 41 patients with atopic keratoconjunctivitis (AKC), 38 patients with vernal keratoconjunctivitis (VKC) and 8 patients with giant papillary conjunctivitis (GPC). All cases were examined for clinical ACD, subjective symptoms, objective findings by the clinical score and by a total tear IgE test. An eosinophil examination by conjunctival smear was also performed in 87 ACD patients.
Results: The most prevalent subjective symptoms were itching (81.6%) and hyperemia (77.6%). The clinical scores of the objective findings in the patients with SAC, PAC, AKC, VKC and GPC were 16.3±3.8 (mean±SD) points, 16.2±2.8, 19.8±6.5, 23.1±5.3, and 21.4±3.9, respectively. In the total tear IgE test 72.2% of the ACD patients were positive; i.e., the ratios were 61.9% in SAC, 65.4% in PAC, 80.5% in AKC, 94.7% in VKC, and 75.0% in GPC. In the examination of eosinophils in the 87 ACD patients, 42.5% (37 eyes) were positive, i.e., the ratio was 20.0% in SAC, 36.8% in PAC, 53.3% in AKC, 75.0% in VKC and 33.3% in GPC. The rate of agreement between the total tear IgE test and the examination of eosinophils was κ=0.28 (Cohen kappa coefficient).
Conclusion: Because of the high positive ratio in patients quasi-definitively diagnosed with ACD, we conclude that the total tear IgE test is useful as an auxiliary method for diagnosing ACD.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 116: 485-493, 2012.

Key words
Allergic conjunctival diseases, Total tear IgE, Immunochromatography, Tear test
Reprint requests to
Jun Shoji, M.D.　Division of Ophthalmology, Department of Visual Sciences, Nihon University School of Medicine. 30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan
Received: 21 July 2011. Accepted in revised form: 27 October 2011.
Nihon Ganka Gakkai Zasshi 116: 485-493,2012