An in vivo confocal masked study on corneal epithelium and subbasal nerves in patients with dry eye.
OBJECTIVE
The objective of the present study was to determine whether dry eye (DE) associated with primary Sjögren's syndrome (PSDE) and DE not associated with Sjögren's syndrome (NSDE) are related to an alteration of corneal innervation.


METHODS
Eleven healthy volunteers younger than 60 years (normal [N] < 60 group), 10 healthy volunteers 60 years of age or older (N > or = 60 group), 11 patients with PSDE, and 10 patients with NSDE were studied. Epithelial and stromal density and subbasal and stromal nerves were investigated by confocal microscopy.


RESULTS
The density of the superficial epithelial cells was 741 +/- 306 cells/mm2 in the PSDE group; 1022 +/- 331 cells/mm2 in the NSDE group; 1523 +/- 294 cells/mm2 in the N > or = 60 group, and 1529 +/- 341 cells/mm2 in the N < 60 group (P < 0.0001, ANOVA). The number of subbasal nerves was 2.8 +/- 1.2 in the PSDE group, 3.3 +/- 0.7 in the NSDE group, 3.1 +/- 0.9 in the N > or = 60 group, and 4.6 +/- 0.8 in the N < 60 group (P < 0.0001, ANOVA). The number of beadlike formations observed in the different groups was 387 +/- 62/mm in the PSDE group, 323 +/- 64/mm in the NSDE group, 182 +/- 63/mm in the N > or = 60 group, and 198 +/- 66/mm in the N < 60 group (P < 0.0001, ANOVA). A correlation was found between the number of subbasal nerves and age (P < 0.01) and between the number of subbasal nerves and Schirmer's test (P < 0.001, Spearman rho).


CONCLUSIONS
Patients with DE show alteration in the corneal innervations. The demonstration of such alterations introduces new strategies for treatment of this frequent disease.
Benítez del Castillo
José M
JM
Unidad de Superficie e Inflamación Ocular, Hospital Clínico San Carlos, Madrid, Spain. jbs00004@teleline.es
Wasfy
Mohamed A S
MA
Fernandez
Cristina
C
Garcia-Sanchez
Julian
J
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002452:Cell Count; D003315:Cornea / Q000294:innervation*; D015352:Dry Eye Syndromes / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009420:Nervous System / Q000473:pathology; D015203:Reproducibility of Results; D016037:Single-Blind Method; D012859:Sjogren's Syndrome / Q000150:complications*