Corneal epithelial opacity in dysfunctional tear syndrome.

PURPOSE To compare the appearance of the superficial corneal epithelium in patients with dysfunctional tear syndrome (DTS) and that of an asymptomatic control group using laser scanning confocal microscopy and to determine the correlations between confocal microscopic findings and clinical severity parameters. DESIGN Prospective case-control study. METHODS Thirty-one patients with newly diagnosed DTS and 21 asymptomatic control subjects were evaluated for this study. Subjects with DTS were classified into 4 levels of clinical severity (DTS 1 through 4) based on the Delphi dry eye panel report criteria. The Heidelberg Retina Tomograph 2 Rostock Cornea Module (Heidelberg Engineering GmbH, Heidelberg, Germany) laser scanning confocal microscope was used to image the superficial corneal epithelium. Areas of single or multiple opaque superficial epithelial cells were measured as a percentage of the 400 x 400-microm(2) field area in 4 randomly selected confocal images from each eye. Spearman correlations between the confocal findings and severity of symptoms, visual acuity, and ocular surface signs were calculated. RESULTS The mean area of opaque superficial corneal epithelial cells was significantly greater in DTS patients than in normal subjects (P < .0001). Significant differences were observed between the DTS severity groups and the control group (P < .001), except for the DTS 1 group. The area of opaque cells significantly increased with level of clinical severity. The confocal findings showed significant correlation with clinical severity parameters, including blurred vision symptoms (r = 0.86; P = .0001), best-corrected visual acuity (Spearman r = 0.4; P = .03), conjunctival lissamine green staining scores (Spearman r = 0.4; P = .026), corneal fluorescein staining scores (Spearman r = 0.5; P = .002), and videokeratoscopic surface regularity index (Spearman r = 0.5; P = .02). CONCLUSIONS Morphologic changes in the superficial corneal epithelium of DTS patients detected by laser scanning confocal microscopy correlates with blurred vision symptoms and objective severity parameters. Objective confocal image analysis of the superficial corneal epithelium may prove useful for classifying DTS severity and for monitoring the efficacy of therapies.

[1]  Lee Stern,et al.  Dysfunctional Tear Syndrome: A Delphi Approach to Treatment Recommendations , 2006, Cornea.

[2]  J. Németh,et al.  In vivo confocal laser scanning microscopy of the cornea in dry eye , 2006, Graefe's Archive for Clinical and Experimental Ophthalmology.

[3]  Francesco Viola,et al.  The cornea in Sjogren's syndrome: an in vivo confocal study. , 2007, Investigative ophthalmology & visual science.

[4]  R. Klein,et al.  Prevalence of and risk factors for dry eye syndrome. , 2000, Archives of ophthalmology.

[5]  Min-Hsiu Shih,et al.  Effect of artificial tears on corneal surface regularity, contrast sensitivity, and glare disability in dry eyes. , 2002, Ophthalmology.

[6]  De-Quan Li,et al.  Apical corneal barrier disruption in experimental murine dry eye is abrogated by methylprednisolone and doxycycline. , 2006, Investigative ophthalmology & visual science.

[7]  R. Guthoff,et al.  In Vivo Investigations of the Corneal Epithelium With the Confocal Rostock Laser Scanning Microscope (RLSM) , 2006, Cornea.

[8]  S. Yeh,et al.  Apoptosis of ocular surface cells in experimentally induced dry eye. , 2003, Investigative ophthalmology & visual science.

[9]  S. Pflugfelder,et al.  Assessing the severity of keratitis sicca with videokeratoscopic indices. , 2002, Ophthalmology.

[10]  William Farley,et al.  Tear cytokine profiles in dysfunctional tear syndrome. , 2009, American journal of ophthalmology.

[11]  H. Taylor,et al.  The epidemiology of dry eye in Melbourne, Australia , 1998 .

[12]  F. K. Manuel,et al.  The incidence and risk factors for developing dry eye after myopic LASIK. , 2006, American journal of ophthalmology.

[13]  M. Iester,et al.  Low spatial-contrast sensitivity in dry eyes. , 1998, Cornea.

[14]  De-Quan Li,et al.  Production and activity of matrix metalloproteinase-9 on the ocular surface increase in dysfunctional tear syndrome. , 2009, Investigative ophthalmology & visual science.

[15]  Gerd Geerling,et al.  Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye WorkShop (2007). , 2007, The ocular surface.

[16]  S. Pflugfelder.  Antiinflammatory therapy for dry eye. , 2004, American journal of ophthalmology.

[17]  S. Pflugfelder.  Anti-inflammatory therapy of dry eye. , 2003, The ocular surface.

[18]  Assessment of the European classification criteria for Sjögren's syndrome in a series of clinically defined cases: results of a prospective multicentre study. The European Study Group on Diagnostic Criteria for Sjögren's Syndrome. , 1996, Annals of the rheumatic diseases.

[19]  S. Kaufman,et al.  Clinical corneal confocal microscopy. , 2006, Survey of ophthalmology.

[20]  Y. Konttinen,et al.  Corneal innervation and morphology in primary Sjögren's syndrome. , 2003, Investigative ophthalmology & visual science.

[21]  A. Knoll,et al.  UV light-damaged DNA and its interaction with human replication protein A: an atomic force microscopy study. , 2002, Nucleic acids research.

[22]  J. García-Sánchez,et al.  An in vivo confocal masked study on corneal epithelium and subbasal nerves in patients with dry eye. , 2004, Investigative ophthalmology & visual science.

[23]  B. Munoz,et al.  Prevalence of dry eye among the elderly. , 1997, American journal of ophthalmology.