In vivo confocal evaluation of the ocular surface morpho-functional unit in dry eye.

Abstract

PURPOSE:

To study, by a new, integrated, laser scanning confocal microscopy approach, the ocular surface morpho-functional unit in patients with primary Sjogren syndrome (SSI), non-Sjogren syndrome dry eye (non-SSDE), and meibomian gland disease (MGD).

METHODS:

Patients and age- and sex-matched control subjects (N = 60; 15 each) were consecutively enrolled in a prospective case-control study. Laser scanning confocal microscopy was used to obtain simultaneous optical sampling of the ocular surface components: cornea, bulbar and tarsal conjunctiva, MGs, and eyelid margin.

RESULTS:

For all superficial epithelia, except eyelid margins, there were reduced cell densities in each group compared with that in controls (p < 0.001). The lowest cell densities were in the SSI group (p < 0.001). Eyelid margin superficial cell density was decreased only in MGD (p < 0.001). Basal epithelial cell density at the corneal apex was increased in both SSI and non-SSDE compared with that in controls (p < 0.01). In the conjunctiva, it was decreased in each group compared with that in controls (p < 0.01). Subbasal dendritic cell density was significantly increased in both SSI and MGD compared with that in controls (p < 0.01). Conjunctival inflammatory cell density and MG inflammation were increased in each group compared with those in controls (p < 0.001), with the highest values in SSI. Subbasal nerve plexi had fewer fibers and higher bead density in each group compared with those in controls (p < 0.001). There was increased tortuosity in both SSI and MGD (p < 0.001). Patients with MGD had the lowest MG acinar density, the largest diameter of acini and acinar orifices, and the highest secretion reflectivity (p < 0.001).

CONCLUSIONS:

Laser scanning confocal microscopy can provide an in vivo, noninvasive, high-resolution overview of the ocular surface morpho-functional unit. This confocal integrated approach may be useful in both research and clinical settings.

• Authors: Edoardo Villani, Fabrizio Magnani, Francesco Viola, Alessandro Santaniello, Raffaella Scorza, Paolo Nucci, Roberto Ratiglia
• Journal: Optometry and vision science : official publication of the American Academy of Optometry (Optom Vis Sci) Vol. 90 Issue 6 Pg. 576-86 (Jun 2013) ISSN: 1538-9235 [Electronic] United States
• PMID: 23670123 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Case-Control Studies
• Cell Count
• Conjunctiva (pathology)
• Dry Eye Syndromes (pathology)
• Epithelial Cells (pathology)
• Epithelium, Corneal (pathology)
• Eyelids (pathology)
• Female
• Humans
• Male
• Microscopy, Confocal
• Middle Aged
• Prospective Studies
• Young Adult