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Michael E. Stern, Jianping Gao, Tammy A. Schwalb, Mylinh Ngo, David D. Tieu, Chi-Chao Chan, Brenda L. Reis, Scott M. Whitcup, Darby Thompson, Janine A. Smith; Conjunctival T-Cell Subpopulations in Sjögren’s and Non-Sjögren’s Patients with Dry Eye. Invest. Ophthalmol. Vis. Sci. 2002;43(8):2609-2614.
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purpose. To examine the conjunctiva of patients with Sjögren’s syndrome keratoconjunctivitis sicca (SS-KCS) and non-Sjögren’s keratoconjunctivitis sicca (NS-KCS) for evidence of immune-based inflammation.
methods. Conjunctival biopsy specimens were obtained from 15 patients with SS-KCS and 15 with NS-KCS. Immunohistochemistry was performed on frozen sections to characterize and quantify T-cell subtypes (CD3, CD4, and CD8) and markers of immune activation (major histocompatibility complex [MHC] class II: HLA-DR, HLA-DQ) and inflammation (intercellular adhesion molecule [ICAM]-1). The numbers of cells positive for each marker were counted by two masked observers and averaged.
results. Conjunctival biopsy specimens from patients with SS-KCS or NS-KCS revealed lymphocytic infiltration and increased immunoreactivity for the markers of inflammation and immune activation. The extent of cellular immunoreactivity did not differ significantly between SS-KCS and NS-KCS tissue samples.
conclusions. The authors’ findings indicate that patients with SS-KCS or NS-KCS have conjunctival inflammation manifested by inflammatory cell infiltrates and upregulation of expression in markers of immune activation. Clinical symptoms of KCS may be more dependent on T-cell activation and resultant inflammation than previously believed. In addition to tear substitutes, anti-inflammatory therapeutics should be investigated for the treatment of KCS.
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