title: Corneal epithelial opacity in dysfunctional tear syndrome.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Ocular Surface Center, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Chen
authors.forename: Kavita
authors.initials: K
authors.lastname: Rao
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Pflugfelder
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003228:Conjunctiva / Q000378:metabolism; D003318:Corneal Opacity / Q000175:diagnosis / Q000209:etiology*; D015352:Dry Eye Syndromes / Q000145:classification / Q000150:complications* / Q000175:diagnosis; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D019793:Fluorescein; D006801:Humans; D008086:Lissamine Green Dyes; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism
chemical_list: D008086:Lissamine Green Dyes; D019793:Fluorescein