Evaluation of the corneal epithelium in non-Sjögren's and Sjögren's dry eyes: An in vivo confocal microscopy study using the HRT III RCM

Abstract

Purpose : To describe the morphological features and evaluate the cell density within the superficial, wing and basal epithelial layers of the cornea in patients with non-Sjögren's (NSDE) and Sjögren’s syndrome dry eyes (SSDE) by in vivo confocal microscopy (IVCM).

Methods : In this IRB-approved study, central corneal images were prospectively captured from 10 age-matched healthy control eyes, 24 eyes with clinically diagnosed dry eye and 43 eyes with clinically diagnosed Sjögren's syndrome, using IVCM. Morphological changes in the corneal epithelial layers and cellular densities were evaluated by four trained graders from the Doheny Image Reading Center.

Results : Images obtained by IVCM from 77 eyes were analyzed. Corneal epithelium in dry eyes presents morphological changes such as areas of enlarged and irregular shaped cells. In comparison with controls, the density of superficial epithelial cells was decreased in both the NSDE (P<0.05) and SSDE groups (P<0.01). The density of the superior layer of wing cells was smaller but not significantly different in NSDE (P>0.05), but was lower in the SSDE group (P<0.01). The density of the inferior layer of wing cells was decreased in both the NSDE (P<0.05) and SSDE groups (P<0.01) and the density of basal epithelial cells was lower in both the NSDE (P<0.01) and SSDE groups (P=0.01). For all cell counts, the interclass correlation coefficient showed good agreement between graders (ICC =0.75 to 0.93).

Conclusions : IVCM represents a reliable technique for examining the corneal epithelial microstructural changes associated with dry eyes, as well as for objectively and reproducibly quantifying cell densities within the corneal epithelial layers.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.