In vivo Confocal Microscopy of the Conjunctiva in Patients With Sjögren’s Syndrome

Abstract

Purpose: : To demonstrate and quantify the level of conjunctival inflammation in patients with Sjögren’s Syndrome (SS) using the Heidelberg Retina Tomograph II (HRTII)/ Rostock Cornea Module confocal microscope in a prospective controlled study.

Methods: : Thirty eyes from 16 Sjögren`s Syndrome patients (15 females and 1 male) and 22 eyes of eleven age and sex matched normal controls without history of any other ocular and systemic disease or surgeries were studied. All subjects underwent Schirmer test, tear film break-up time (BUT), fluorescein, Rose Bengal staining of the ocular surface and confocal laser scan microscopy of the temporal bulbar conjunctiva. The density of the conjuntival inflammatory infiltrates was also measured.

Results: : In vivo confocal microscopy provided high-resolution images of inflammatory infiltrates and leukocytes in the conjunctival epithelium of SS patients. The density of conjunctival inflammatory cells was higher in SS subjects (mean: 409.4 ± 90.5 cells/mm2) compared to normal controls (mean: 5.02 ± 4.14 cells/mm2). Tear stability, quantity and vital staining scores were significantly worse in SS patients compared to normal subjects.

Conclusions: : Using in vivo confocal microscopy, conjunctival inflammation in SS can be evaluated and quantified in an efficient and noninvasive manner. The conjunctival alterations observed at the cellular level and their relations with tear functions are important to increase the understanding of the pathogenesis of keratoconjunctivitis sicca and the associated ocular surface disease. Another potential use is for the assessment of the outcome of therapeutic approaches aimed at controlling the inflammatory process in dry eye.

Clinical Trial: : Tokyo,Keio University,17-129(1)

Keywords: conjunctiva • imaging/image analysis: clinical • cornea: tears/tear film/dry eye