Characterization of corneal epithelia in Sjögren's syndrome associated dry eye disease by In Vivo Confocal Microscopy

Abstract

Purpose: To describe the morphological features of the corneal epithelial layers in patients with dry eyes associated with Sjögren's syndrome (SS) by using in vivo confocal microscopy (IVCM).

Methods: Central cornea images were prospectively captured from 43 eyes with clinically diagnosed Sjögren's syndrome and 10 age matched healthy control eyes using In Vivo Laser Scanning Confocal Microscopy (Heidelberg Retina Tomograph Rostock Cornea Module - HRT III RCM). Morphological changes of the corneal superficial, wing, and basal epithelial layers were evaluated and the quantification of wing and basal cells density was performed by two independent masked observers, using the semi-automated cell count software provided by the microscope.

Results: Images obtained by IVCM from 53 eyes were analyzed. As compared to controls, SS affected eyes exhibit increased desquamation, larger cells and enhanced reflectivity of the superficial epithelial cells. Local alterations were observed within the wing and basal epithelial layers, including enlarged and irregularly shaped cells. The density of the wing cells was similar between the SS group and the control group (4923±838 cells/mm2 vs. 4762±416 cells/mm2, p=0.56), while the density of basal epithelial cells showed a tendency of reduction in the affected eyes, without reaching statistical significant difference between the SS group and the control group (5628±581 cells/mm2 vs. 6076±459 cells/mm2, p=0.05).

Conclusions: IVCM reveals morphological changes in the corneal epithelial layers of patients with SS as compared to normal corneas. Yet, the overall density of wing and basal cells for our cohort is similar between the control and diseased corneas. IVCM may be a useful tool that allows detection of subclinical changes in the corneal epithelium of eyes affected by SS.