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Correlation between corneal innervation and inflammation evaluated with confocal microscopy and symptomatology in patients with dry eye syndromes: a preliminary study

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Abstract

Purpose

To evaluate corneal innervation and inflammatory cell infiltration using in vivo confocal microscopy (IVCM) and to correlate these findings with subjective symptoms of dry eye, as measured by the Ocular Surface Disease Index (OSDI) in patients with non-Sjögren’s (NSDE) and Sjögren’s syndrome dry eyes (SSDE).

Methods

Central corneal images were prospectively captured from 10 age-matched healthy control eyes, 24 eyes with clinically diagnosed NSDE and 44 eyes with clinically diagnosed SSDE, using IVCM (HRT III RCM). Density, tortuosity and reflectivity of corneal nerves, presence of inflammatory dendritic cells (DCs) and OSDI scores were evaluated.

Results

Images obtained by IVCM from 78 eyes were analyzed. The density of nerve fibers was 1562 ± 996 μm/frame in the SSDE group, 2150 ± 1015 μm/frame in the NSDE group and 2725 ± 687 μm/frame in the control group (P < 0.05, ANOVA). In comparison to the control group, the density of nerve fibers was decreased in the SSDE (P < 0.001) and the NSDE groups (P = 0.06), with increased nerve tortuosity and decreased reflectivity in both groups (both P < 0.05). The density of DCs was 71.65 ± 72.54 cells/mm2 in the SSDE group, 40.33 ± 31.63 cells/mm2 in the NSDE group and 27.53 ± 5.58 cells/mm2 in the control group (P < 0.05, ANOVA). In comparison to the control group, the density of DCs was increased in the SSDE (P < 0.001) and the NSDE groups (P = 0.07). Significant correlations were found between the nerve density and DC density (r = −0.57, P < 0.001), between the nerve density and OSDI scores (r = −0.91, P < 0.001) and between the nerve reflectivity and OSDI scores (r = −0.75, P < 0.001).

Conclusions

The corneas of eyes affected with NSDE and SSDE are characterized by alterations in corneal innervation and infiltration of inflammatory DCs. Corneal nerve density and reflectivity are correlated with severity of subjective dry eye symptoms, as measured by OSDI score.

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Acknowledgements

We would like to thank Dr. Vikas Chopra for providing insight and expertise that greatly assisted the research and for comments that greatly improved the manuscript.

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Authors and Affiliations

  1. Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, DVRC 211, Los Angeles, CA, 90033, USA

    Tudor C. Tepelus, Jianyan Huang, Ping Huang, SriniVas R. Sadda & Olivia L. Lee

  2. USC Roski Eye Institute, Keck School of Medicine, 1450 San Pablo Street, Los Angeles, CA, 90033, USA

    Gloria B. Chiu

  3. Department of Ophthalmology, David Geffen School of Medicine at UCLA, 100 Stein Plaza UCLA, Los Angeles, CA, 90095, USA

    Tudor C. Tepelus, Jianyan Huang, Ping Huang, SriniVas R. Sadda, John Irvine & Olivia L. Lee

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  1. Tudor C. Tepelus
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Correspondence to Olivia L. Lee.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Tepelus, T.C., Chiu, G.B., Huang, J. et al. Correlation between corneal innervation and inflammation evaluated with confocal microscopy and symptomatology in patients with dry eye syndromes: a preliminary study. Graefes Arch Clin Exp Ophthalmol 255, 1771–1778 (2017). https://doi.org/10.1007/s00417-017-3680-3

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