In the current study, we have determined the associations between nine mediators (IL-6, IL-10, CXCL8/IL-8, CCL5/RANTES, MMP-9, MMP-13, TIMP-1, t-PA, and PAI-1) in the tear fluid of keratoconic patients covering the whole spectrum of the disease (from subclinical to manifest keratoconus). Here, MMP9 is linked to keratoconus.