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

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.