J Korean Ophthalmol Soc.  2015 May;56(5):680-686. 10.3341/jkos.2015.56.5.680.

Corneal Microstructural Changes in Non-Sjogren Dry Eye Using Confocal Microscopy: Clinical Correlation

• Choi EY
• Kim TI
• Seo KY
• Kim EK
• Lee HK

• KMID: 2121164
• DOI: http://doi.org/10.3341/jkos.2015.56.5.680

Abstract

PURPOSE
To investigate the relationship between changes of corneal epithelium and subbasal nerves in non-Sjogren dry eye using in vivo confocal microscope (IVCM) and self-reported clinical symptoms.
METHODS
The present study included 40 patients with dry eye and 18 healthy control subjects. The dry eye group underwent an evaluation of dry eye symptoms using visual analogue scale (VAS) score and was subdivided into 2 groups; score 0-5 as the low VAS score (LVS) group and score 6 - 10 as the high VAS score (HVS) group. The tear film break-up time, fluorescein staining, Schirmer test and microstructural imaging of epithelium, and subbasal nerve at cornea center with IVCM were performed on both eyes of each patient. Twenty-three normal eyes and 54 eyes of dry eye patients were included in the study. Cell densities and morphological characteristics were analyzed using ImageJ and NeuronJ softwares.
RESULTS
Both LVS and HVS groups had decreased cell density of superficial, intermediate, and basal epithelium (p < 0.001). Intermediate epithelial cells were more decreased in the dry eye group with more severe symptoms (p < 0.0001). Subbasal nerve density (p < 0.005) was more decreased and nerve beadings, tortuosity, and reflectivity increased in the HVS group than both LVS and control groups (p < 0.05).
CONCLUSIONS
The alterations of corneal cellular level in dry eye patients visualized using IVCM are correlated with pathology and clinical symptoms and may be useful objective criteria in diagnosis and monitoring treatment efficacy.

Keyword

Confocal microscopy; Dry eye; In vivo confocal microscopy (IVCM); Non-Sjogren dry eye

MeSH Terms

Cell Count
Cornea
Diagnosis
Epithelial Cells
Epithelium
Epithelium, Corneal
Fluorescein
Humans
Microscopy, Confocal*
Pathology
Tears
Treatment Outcome
Fluorescein

Figure

• 

  Figure 1. In vivo confocal images of cornea. Superficial epithelium. Compared with (A), (B), and (C) had more decreased cell density. (A) Showing regularly arranged cells with dark nuclei. (B) and (C) showing squamous metaplasia, hyperreflectivity as compared to control. Intermediate epithelium. Compared with (D) and (E), (F) had more decreased cell density. Basal epithelium. Compared with (G), (H) and (I) had more decreased cell density. Bar, 100 μ m. LVS = low visual analogue scale score; HVS = high visual analogue scale score.

• 

  Figure 2. In vivo confocal images of cornea. Subbasal nerve. Compared with (A) and (B), (C) had more decreased subbasal nerve density and had more increased subbasal nerve beadings, tortuosity, and reflectivity. Bar, 100 μ m. LVS = low visual analogue scale score; HVS = high visual analogue scale score.

Reference

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