title: Conjunctival in vivo confocal scanning laser microscopy in patients with Sjögren syndrome.
abstract: OBJECTIVE
  To demonstrate the conjunctival alterations in patients with Sjögren's (SSDE) and non-Sjögren's syndrome dry eye (NSSDE) using a new generation confocal microscope (HRTII/ RCM; Heidelberg Engineering, Heidelberg, Germany), in a prospective controlled study.
  
  
  METHODS
  Twenty-eight right eyes of 28 patients with SSDE (28 women; mean age, 58.2 +/- 14.3 years), 7 right eyes of patients with NSSDE (7 women; mean age, 66.1 +/- 14.4 years), and 14 right eyes of 14 age- and sex-matched control subjects were studied. All subjects underwent the Schirmer test, tear film breakup time (BUT), vital staining, and confocal microscopy of the temporal bulbar conjunctiva. The density of conjunctival epithelial cells, epithelial microcysts, and conjunctival and corneal inflammatory infiltrates were also assessed.
  
  
  RESULTS
  The tear quantity, stability, and vital staining scores were significantly worse in patients with SSDE or NSSDE than in control subjects (P < 0.001 and P < 0.05, respectively). Eyes of the patients with SSDE or NSSDE had a significantly higher density of conjunctival and corneal inflammatory infiltrates than did the control eyes (P < 0.001). Conjunctival inflammatory cell densities showed a negative correlation with tear stability and tear quantity and a positive correlation with the vital staining scores. Conjunctival epithelial cell densities were significantly lower in SSDE and NSSDE compared with control subjects (P < 0.05). The density of epithelial cysts was significantly higher in SS than in healthy control eyes (P < 0.001).
  
  
  CONCLUSIONS
  Confocal scanning laser microscopy was an efficient and a noninvasive tool for the quantitative assessment of the conjunctival inflammation and epithelial cell densities as well as evaluation of conjunctival morphologic alterations, such as microcysts in patients with SSDE and NSSDE dry eye disease.
authors.affiliation: Johnson and Johnson Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Tais Hitomi
authors.initials: TH
authors.lastname: Wakamatsu
authors.forename: Enrique Adan
authors.initials: EA
authors.lastname: Sato
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Osama M A
authors.initials: OM
authors.lastname: Ibrahim
authors.forename: Murat
authors.initials: M
authors.lastname: Dogru
authors.forename: Minako
authors.initials: M
authors.lastname: Kaido
authors.forename: Reiko
authors.initials: R
authors.lastname: Ishida
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000368:Aged; D002452:Cell Count; D003228:Conjunctiva / Q000473:pathology*; D015352:Dry Eye Syndromes / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology*; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D006801:Humans; D007637:Keratoconjunctivitis / Q000473:pathology*; D018613:Microscopy, Confocal; D008875:Middle Aged; D011446:Prospective Studies; D012859:Sjogren's Syndrome / Q000378:metabolism / Q000473:pathology*; D013666:Tears / Q000737:chemistry / Q000378:metabolism