Tear Cytokine Profiling in Vernal Keratoconjunctivitis Identifies Immune Signatures Associated with Disease Severity

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Background: Vernal keratoconjunctivitis (VKC) is a chronic pediatric ocular allergic disease that can progress from seasonal to persistent inflammation with vision-threatening complications. While Th2 mechanisms are implicated, immune correlates of disease severity remain unclear. Methods: Tear samples from VKC patients (moderate intermittent and moderate persistent) and healthy controls were collected using Schirmer’s strips. Cytokine profiling was performed using the OLINK® Target 48 Cytokine Panel. Differential expression, correlation with clinical features, and pathway enrichment analyses were conducted. Results: IL-15, CXCL11, CXCL9, MMP12, and CCL13 were significantly elevated in VKC compared to controls, with higher levels in the persistent phenotype. These cytokines correlated with symptom duration, limbal involvement, and papillary hypertrophy. Pathway analysis revealed enrichment of IL-17, JAK–STAT, and chemokine signaling pathways. Conclusions: VKC severity is associated with distinct tear cytokine signatures, with the persistent phenotype showing enhanced chronic inflammatory signaling. Tear cytokines may serve as non-invasive biomarkers for disease monitoring and therapeutic stratification in paediatric VKC.

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