Preliminary evidence of the efficacy of probiotic eye-drop treatment in patients with vernal keratoconjunctivitis

Alfonso Iovieno, Alessandro Lambiase, Marta Sacchetti, Barbara Stampachiacchiere, Alessandra Micera, Stefano Bonini

Research output: Contribution to journalArticlepeer-review


Background: Probiotics have been shown to improve allergic inflammation. The aim of this study was to evaluate the efficacy of Lactobacillus Acidophilus eye-drops in controlling signs and symptoms of vernal keratoconjunctivitis (VKC). Methods: Seven patients (mean age 11.8±4.3; five M, two F) with mild to moderate VKC were included in the study. Lactobacillus Acidophilus diluted in saline solution (2±108 CFU/ml) was administrated as eye-drops four times daily for 4 weeks in both eyes. Clinical signs (conjunctival hyperemia, chemosis, secretion, Trantas dots, superficial punctuate keratitis) and symptoms (itching, photophobia, burning, tearing) were evaluated and scored from 0 to 3 at baseline, after 2 and 4 weeks of treatment. Total sign (TSS) and symptom (TSyS) scores were calculated. Conjunctival impression cytology was performed in three patients at baseline and after 4 weeks of treatment, in order to evaluate the expression of ICAM-1 and TLR-4. Results: In the six out of seven patients who completed the study, symptoms were significantly improved after both 2 weeks (TSyS: baseline 6.7±0.9 vs 4.1±1.2; p=0.017) and 4 weeks (TSyS: baseline 6.7±0.9 vs 3.6±1.2, p=0.011) of treatment. A significant improvement of clinical signs was observed after 4 weeks of treatment (TSS: baseline 7.5±1.6 vs 3.9±1.7, p=0.034) but not after 2 weeks of treatment (TSS: baseline 7.5±1.6 vs 5.3±1.5; NS). In particular, photophobia was significantly reduced (2±0.6 vs 1±0.3; p=0.023) at 2 weeks, while at 4 weeks the scores for itching (1.8±0.3 vs 1±0.3), tearing (1.6±0.4 vs 0.8±0.2), conjunctival hyperemia (2.3±0.2 vs 1.4±0.5) and chemosis (1.2±0.4 vs 0.4±0.4) were significantly lower compared to baseline. A down-regulation of ICAM-1 and TLR-4 was observed in two patients showing clinical improvement after 4 weeks of treatment. Conclusion: Our open pilot study showed that 1-month treatment with probiotic eye-drops improves signs and symptoms in patients with VKC. Additional double-blind controlled clinical trials with a larger sample of patients are needed to confirm the effects of topical Lactobacilli on VKC patients.

Original languageEnglish
Pages (from-to)435-441
Number of pages7
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Issue number3
Publication statusPublished - Mar 2008


  • Allergy
  • Conjunctiva
  • Lactobacillus Acidophilus
  • Probiotic
  • Vernal keratoconjunctivitis

ASJC Scopus subject areas

  • Ophthalmology


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