Reduced Corneal Endothelial Cell Density in Patients With Dry Eye Disease

Abstract

Purpose To evaluate corneal endothelial cell density (ECD) in patients with dry eye disease (DED) compared to an age-matched control group. Design Cross-sectional, controlled study Methods This study included 90 eyes of 45 patients with moderate-to-severe DED (53.7 ± 9.8 years old) and 30 eyes of 15 normal controls (50.7 ± 9.8 years old). All subjects had a complete ophthalmic evaluation including symptom assessment using the Ocular Surface Disease Index (OSDI) and corneal fluorescein staining. In addition, laser scanning in vivo confocal microscopy was performed to measure the density of the following parameters in the central cornea: endothelial cells, subbasal nerves, and subbasal immune dendritic cells. Results Corneal ECD was significantly lower in the DED group (2595.8 ± 356.1 cells/mm2) than in the control group (2812.7 ± 395.2 cells/mm2, P=0.046). The DED group showed significantly lower corneal subbasal nerve density (17.1 ± 6.9 mm/mm2) compared to the control group (24.7 ± 4.4 mm/mm2, P<0.001). Dendritic cell density was significantly higher in the DED group than in the controls (111.7 ± 137.3 versus 32.0 ± 24.4 cells/mm2, respectively, P=0.002). There were statistically significant correlations between corneal ECD and dry eye severity parameters including the OSDI score (rs= −0.26, P=0.03), and corneal fluorescein staining (rs= −0.28, P=0.008). Conclusions There is a significant reduction in corneal ECD in DED which correlates with clinical severity of the disease.

Longitudinal Changes to Tight Junction Expression and Endothelial Cell Integrity in a Mouse Model of Sterile Corneal Inflammation

“…In addition to the well-recognized detrimental effects of longterm contact lens wear on endothelial health, which occur mostly due to hypoxia, 27,28 the involvement of the corneal endothelium in response to epithelial or ocular surface abnormalities is gaining increasing attention. Endothelial cell density is reduced in patients with dry eye disease 29 and neurotrophic keratitis, 30 supporting a close interaction between ocular surface health and the integrity of the corneal endothelium. Our data suggest that a sterile, debridement injury to the corneal epithelium is sufficient to induce polymegethism of endothelial cells after 1 week, which persists up to 4 weeks.…”

Patients With Dry Eye Disease and Low Subbasal Nerve Density Are at High Risk for Accelerated Corneal Endothelial Cell Loss

“…The CECD measurement was performed using variable frame-method. 7,18 To do this, IVCM images were exported and then analyzed using ImageJ. First, the boundary of the largest possible area in which all cell borders were clearly distinct was traced using Polygon Selection tool of ImageJ.…”

“…7 The cornea has the highest nerve density in the body, 8,9 and these nerves are known to provide a trophic support for the corneal epithelium. 9,10 As simultaneous reduction of corneal nerves and endothelial cells has been observed in many local and systemic conditions, 11–15 we previously suggested that these nerves may play a role in the maintenance of corneal endothelial cell function and survival.…”

“…9,10 As simultaneous reduction of corneal nerves and endothelial cells has been observed in many local and systemic conditions, 11–15 we previously suggested that these nerves may play a role in the maintenance of corneal endothelial cell function and survival. 7,16 …”

Advances in dry eye imaging: the present and beyond

“…Morphological changes may not be limited to the ocular surface: in moderate to severe DED. There is a significant reduction in central corneal endothelial cell density which is correlated with the severity of DED 59. This observation remains to be investigated but these structural changes may be due to a common inflammatory pathway.…”