LTA and keratoconus: Our findings of reduced tear LT-α in KC may reflect multiple mechanisms: (1) impaired immune homeostasis, as LT-α is crucial for lymphoid tissue development and T-cell regulation, with its deficiency potentially disrupting corneal repair; (2) compensatory downregulation due to chronic inflammation, similar to observations in dry eye disease; and (3) broader immune dysfunction, consistent with lymphocyte depletion in KC.