Albumin in tears

Abstract

Albumin is not endogenous to the tear film and is present as a product of plasma leakage. It is used as a diagnostic marker of ocular insult and inflammation. Tear albumin is, however, poorly understood, with large variations in reported concentrations between studies. There is also no authoritative information on whether its presence in tears is responsive or part of an adaptive reaction.The presented research aimed to resolve the disparities in published tear albumin concentrations and investigate the role of albumin in the tear film. Collation and evaluation of the available literature identified collection method, stimulus, assay technique, and disease state as factors able to influence quoted tear albumin to different extents. Difference in sampling technique exhibited the largest variations in mean tear albumin concentrations. Review of the literature also highlighted that little systematic investigations of the daily cycle of tear albumin levels, and subject-to-subject-variation, had been carried out. In order to remedy this shortcoming, variations in tear albumin concentration were investigated in 13 subjects throughout the waking day. Results identified a time period where albumin levels are relatively stable (2-6 hours post-waking). This was designated a suitable baseline for the determinations of tear albumin concentrations and subject-to-subject comparisons. Significantly, a previously unrecognised progressive increase in albumin concentration during the latter part of the day was also identified in the population. This increase suggests that albumin may play a more active and dynamic role in the ocular environment than is commonly perceived. To facilitate the collection of additional tear albumin data, tear sampling and point-of-care analysis in contact lens clinics were investigated. Two instruments were evaluated and were found to be suitable for the analysis of tear albumin in commercial institutions. Collectively, the described research has provided new insight into tear albumin and a strong foundation for further studies.