Keratoconus is a progressive corneal ectasia that leads to severe visual impairment and remains one of the main causes of corneal keratoplasty worldwide. The increased risk observed in first-degree relatives of patients with keratoconus, together with the higher concordance of the disease in monozygotic over dizygotic twins, support the strong genetic component of keratoconus and make family history one of the main risk factors for its development. In addition, corneal biomechanical weakness is a hallmark of the early stages of this pathology, where the corneal tissue progressively weakens as the disease progresses. Although the pathophysiology of keratoconus is increasingly unraveling, the molecular factors and pathways intertwined in the early and at-risk disease states are still largely unknown. In this sense, this work focuses on identifying the tear proteomic biomarkers and paths related to the corneal biomechanical weakness and keratoconus at-risk stages. Furthermore, new insights into lactoferrins involvement in the keratoconus disease and its immunomodulatory capacity as a therapeutic approach are also provided.
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