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

Edoardo Villani, Fabrizio Magnani, Francesco Viola, Alessandro Santaniello, Raffaella Scorza, Paolo Nucci, Roberto Ratiglia

Research output: Contribution to journalArticlepeer-review

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-funcional unit. This confocal integrated approach may be useful in both research and clinical settings.

Original languageEnglish
Pages (from-to)576-586
Number of pages11
JournalOptometry and Vision Science
Volume90
Issue number6
DOIs
Publication statusPublished - Jun 2013

Keywords

  • conjunctiva
  • cornea
  • dry eye
  • imaging
  • in vivo confocal microscopy
  • inflammation
  • meibomian glands
  • ocular surface
  • Sjogren syndrome

ASJC Scopus subject areas

  • Ophthalmology
  • Optometry
  • Medicine(all)

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