Abstract
Purpose: :
Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease of unknown etiology, which can manifest in inflammation of various ocular tissues, including cornea. Aim of the study was to investigate Langerhans cells (LC) - an indicatior of inflammation in cornea -, and dry eye related parameters in systemic lupus erythematosus (SLE).
Methods: :
Prospective consecutive case series of 32 SLE patients (age: 45.1±11.4 years) and 34 age-matched control (C) subjects (age: 43,8±19,2). SLE patients had no ophthalmic disease or symptoms, did not complain about dry eye. Lid paralell conjuctival folds (LIPCOF), tear break up time (TBUT), Schirmer test, ocular surface disease index (OSDI) have been evaluated, then LC densities were investigated with Heidelberg Retina Tomograph - Rostock Cornea Module (HRT-RCM) confocal microscopy in the central and in the peripheral regions of the cornea. The right eye of each patient was examined. For the comparison of control and SLE groups Mann-Whitney U test was performed (p<0.05 was considered significant).
Results: :
Between SLE and control groups significant differences were detected in three out of four dry eye related parameters: TBUT C: 11.09±3.37s SLE: 6.53±3.45s (p<0.001), Schirmer test C: 11.67±3.21mm, SLE: 7.47±9.50 mm (p=0.003), OSDI C: 11.06±7.18, SLE: 29.56±22.09 (p<0.001). In LIPCOF no significant difference was found between control eyes (1.24±0.54), and SLE patients (1.53±0.76; p=0.171). Central LC density was greater in SLE patients (42.5±45.7 cell/mm2) than in controls 20.57±19.18 cell/mm2, p=0.027. Peripheral LC density was not different (C: 78.00±39.51 cell/mm2, SLE: 119.94±155.21 cell/mm2 (p=0.212).
Conclusions: :
A marked increase of LCs could be demonstrated by in vivo confocal corneal microscopy in the central cornea, which suggests, that SLE alters corneal homeostasis and might contribute to the development of dry eye. Objective parameters and an aimed questionaire (OSDI) pointed out, that SLE patients without significant subjective symptoms might present with signs of dry eye and chronic hyperactivity of the antigen presenting cells.
Keywords: cornea: clinical science • immune tolerance/privilege • imaging/image analysis: clinical