Immunoglobulin A antibodies against Pseudomonas aeruginosa in the tear fluid of contact lens wearers.

PURPOSE Pseudomonas aeruginosa is the most important cause of contact lens-associated ulcerative keratitis, especially for those who use extended-wear lenses. Until now, the presence of specific anti-P. aeruginosa immunoglobulin A (IgA) antibodies in the tears of contact lens wearers has not been investigated and is the purpose of the current study. METHODS The levels of specific IgA antibodies against P. aeruginosa and total secretory IgA (s-IgA) concentrations were measured in tears of various groups of contact lens and non-contact lens wearers using enzyme-linked immunosorbent assays. Contact lens groups were divided into the following categories: daily-wear rigid gas-permeable lenses (n = 23), daily-wear soft lenses (n = 22), extended-wear soft lenses (n = 17), and non-contact lens wearers (n = 23). As a positive control group, we tested tears obtained from patients with cystic fibrosis (n = 5) because the respiratory tract of these persons often are colonized by P. aeruginosa. RESULTS The percentage of nonresponders (< 15 U/ml) varied between 9% in daily-wear rigid gas-permeable contact lens users to 23% in daily-wear soft contact lens users. The percentage of nonresponders in controls was 13%. The frequency of nonresponders was not significantly different among the different groups tested. All patients with cystic fibrosis showed a very high anti-P. aeruginosa IgA response in their tears. When analyzing the mean anti-P. aeruginosa IgA response, a significantly lower level was found in extended-wear contact lens users (38 U/ml) compared to non-contact lens wearers (82 U/ml). Total s-IgA levels in the tears of the various groups tested were not significantly different. CONCLUSIONS A substantial number of persons in the population of contact lens wearers tested lack detectable IgA antibodies against P. aeruginosa in their tears and may be susceptible to P. aeruginosa keratitis if the physiological condition of their cornea is compromised.