In VivoConfocal Microscopy in Dry Eye Disease and Related Conditions

Abstract

A new era of ocular imaging has recently begun with the advent of in vivo confocal microscopy (IVCM), shedding more light on the pathophysiology, diagnosis, and potential treatment strategies for dry eye disease. IVCM is a noninvasive and powerful tool that allows detection of changes in ocular surface epithelium, immune and inflammatory cells, corneal nerves, keratocytes, and meibomian gland structures on a cellular level. Ocular surface structures in dry eye-related conditions have been assessed and alterations have been quantified using IVCM. IVCM may aid in the assessment of dry eye disease prognosis and treatment, as well as lead to improved understanding of the pathophysiological mechanisms in this complex disease. Further, due to visualization of subclinical findings, IVCM may allow detection of disease at much earlier stages and allow stratification of patients for clinical trials. Finally, by providing an objective methodology to monitor treatment efficacy, image-guided therapy may allow the possibility of tailoring treatment based on cellular changes, rather than on clinical changes alone.

Sjogren`s syndrome and ocular surface changes by laser-scanning in vivo confocal microscopy

“…Recently, there are several small studies that quantitated and analyzed morphologic SNP changes (1,12). They found partially conflicting data (1,12). As visible from our results we confirm these observations.…”

“…This system integrated the tear film, lacrimal glands, cornea, conjunctiva, Meibomian glands, lids, and the sensory and motor nerves (10 Previous other confocal findings partly confirmed and led the hypothesis that changes on the epithelium and especially difference in cell density are consequential indicators for tissue damage (1,12). Other in vivo LSCM studies provided several partially validated parameters which included dendric cells (DCs), presumed leukocytes and activated keratocytes (9,11,12).…”

“…These cells could be understood as normal stromal cells in which the light from the confocal microscope ray strikes at an unusual angle. These changes were associated to cornea inflammation in DED patients (1,9,12) or Graves' orbitopathy. But they could be also normal stromal cells.…”

“…They did not describe significant nerve tortuosity and beading changes (1,20). Recently, there are several small studies that quantitated and analyzed morphologic SNP changes (1,12). They found partially conflicting data (1,12).…”

“…They were presumed to be activated keratocytes. They were not histologically described, and could be interpreted in more than one way (1,9,12,19). These cells could be understood as normal stromal cells in which the light from the confocal microscope ray strikes at an unusual angle.…”