In Vivo Confocal Microscopic Evaluation of Corneal Langerhans Cells in Dry Eye Patients§

Abstract

Purpose. To assess inflammatory involvement of cornea in dry eye by means of confocal microscopy, evaluating the presence and distribution of Langherans cells (LCs).Methods: 98 eyes of 49 subjects were enrolled: 18 subjects affected by Sjögren Syndrome Dry Eye (SSDE), 17 with Non-Sjögren Syndrome Dry Eye (NSSDE), 14 healthy volunteeers. Dry eye symptoms, tear film, ocular surface damage and corneal confocal microscopy were analized.Results: A significant increase of LCs density was observed at sub-basal nerve plexus (SSDE = 79 cells/mm2 andNDE = 22 cells/mm2; p = 0,0031) and sub-epithelial nerve plexus (SSDE = 38 cells/mm2 and NDE = 3 cells/mm2; p = 0,0169) in central cornea of SSDE group. An increased number of LCs from the center to the periphery of the cornea was observed, significant only in healthy volunteers group. In dry eye patients there was an increase in LCs density in both peripheral and central cornea with a significant difference between NDE (14,66 cells/mm2) and SSDE (56,66 cells/mm2) only in central cornea (p = 0,0028). In SSDE group, mean density of LCs in central cornea results also superior to NSSDE group (29,33 cells/mm2).There was no correlation between LCs density and dry eye symptoms, tear film deficiency and ocular surface damage.Conclusion: This study demonstrates the activation of an inflammatory and immunological reaction in cornea of NSSDE and SSDE patients. Confocal microscopy can be an important diagnostic tool in evaluation and follow-up of dry eye disease.

Corneal confocal scanning laser microscopy in patients with dry eye disease treated with topical cyclosporine

“…13 Alternatively, they might be related to corneal inflammation representing cells that are in a particular state of metabolic activation, induced by proinflammatory cytokines (IL-1 and TNF). 13,22 Interestingly, we found a progressive decrease in the number of hyperreflective stromal cells consistent with the use of topical cyclosporine administration during follow-up. This finding suggests that their presence is most likely to be related to the level of corneal inflammation and these cells could be used as a parameter to diagnose corneal inflammation and to follow its response to treatment (Figure 2).…”

Reduced association between dendritic cells and corneal sub‐basal nerve fibers in patients with fibromyalgia syndrome

“…Patients with DED of any etiology have a higher LC density in their central cornea than healthy controls, with the highest densities found in autoimmune‐associated DED . LC were larger and had more or longer dendrites in DED patients than in healthy controls.…”

Longitudinal changes in Langerhans cell density of the cornea and conjunctiva in contact lens‐induced dry eye

“…The observation in this study of an initial up‐regulation in corneal LCD in CLIDE versus controls at one and four weeks is consistent with previous reports of higher levels of corneal LCD in dry eye patients. Machetta and colleagues reported a higher LCD in the central cornea of patients with Sjögren syndrome dry eye (SSDE) (79 cells/mm 2 ) compared to those without dry eye (22 cells/mm 2 ) (p = 0.0031). In a similar study, Lin and colleagues reported a higher LCD in the central cornea of patients with both SSDE (128 cells/mm 2 ) and non‐SSDE (90 cells/mm 2 ) compared to those without dry eye (35 cells/mm 2 ).…”