In Vivo Confocal Microscopy of Cornea in Dry Eye Associated With Sjögren Syndrome
Purpose
To describe the morphological features of the corneal epithelial layers, sub-basal nerve plexus and anterior stroma in patients with dry eyes associated with Sjogren's syndrome (SS) by using in vivo confocal microscopy (IVCM).
Methods
Central cornea images were prospectively captured bilaterally from 20 healthy control eyes and 40 eyes with clinically diagnosed Sjogren's syndrome using In Vivo Laser Scanning Confocal Microscopy (HRT III RCM). Morphological changes of the corneal epithelial layers and anterior stroma, as well as characteristics of corneal nerves were evaluated.
Results
Images obtained by IVCM from 60 eyes were analyzed. As compared to controls, Sjogren's dry eyes exhibit increased desquamation of the superficial epithelial cells, becoming more hyper-reflective. Local alterations within the epithelial layers were observed, yet the density of the wing and basal epithelial cells showed no statistical significance between the SS group (4923±838 cells/mm2, 5628±581 cells/mm2) and the control group (4762±416 cells/mm2, 6076±459 cells/mm2). Images of the sub-basal nerve plexus in SS demonstrate significant reduction in density and increased tortuosity. In Sjogren's dry eyes as compared to normal controls, the keratocytes within the anterior stroma appear abnormally hyper-reflective.
Conclusion
IVCM reveals morfostructural changes in the corneas of patients with SS as compared to normal corneas. Our study demonstrated decreased corneal nerve density and increased tortuosity of corneal nerves. Our findings suggest implications for use of IVCM in the evaluation and monitoring of patients with ocular manifestations of SS.