In vivo detection of clinically non-apparent ocular surface inflammation in patients with meibomian gland dysfunction-associated refractory dry eye symptoms: a pilot study

Purpose The utility of in vivo confocal microscopy (IVCM) in the investigation of palpebral conjunctival and corneal inflammation in patients with meibomian gland dysfunction (MGD)-associated refractory dry eye symptoms following gland expression, despite objective clinical improvement. Methods A re...

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Bibliographic Details
Published in:Eye (London) 2015-08, Vol.29 (8), p.1099-1110
Main Authors: Qazi, Y, Kheirkhah, A, Blackie, C, Cruzat, A, Trinidad, M, Williams, C, Korb, D R, Hamrah, P
Format: Article
Language:English
Subjects:
14/19
692/1807/1482
Adult
Aged
Case-Control Studies
Clinical Study
Corneal Edema - etiology
Corneal Edema - pathology
Dry Eye Syndromes - etiology
Dry Eye Syndromes - pathology
Dry Eye Syndromes - physiopathology
Female
Humans
Laboratory Medicine
Male
Medicine
Medicine & Public Health
Meibomian Glands - secretion
Middle Aged
Ophthalmology
Pharmaceutical Sciences/Technology
Pilot Projects
Retrospective Studies
Surgery
Surgical Oncology
Tears - metabolism
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Summary:Purpose The utility of in vivo confocal microscopy (IVCM) in the investigation of palpebral conjunctival and corneal inflammation in patients with meibomian gland dysfunction (MGD)-associated refractory dry eye symptoms following gland expression, despite objective clinical improvement. Methods A retrospective, observational pilot study was conducted evaluating five patients with MGD-associated refractory dry eye symptoms and three control groups: symptomatic untreated MGD patients ( n =3), treatment-responsive MGD patients with improved symptoms ( n =3) and asymptomatic healthy normals ( n =11). Ocular surface disease index (OSDI) scores, tear break-up time (TBUT), the number of meibomian glands yielding liquid secretion (MGYLS), palpebral conjunctival epithelial and substantia propria immune cell (EIC, SIC), and corneal dendritic cell (DC) densities were measured. Results Despite clinical improvement (TBUT: 6.4±1.2 s to 10.1±2.1 s, P =0.03; MGYLS: 3.5±0.8 glands to 7.0±1.1 glands, P =0.13) and a normal clinical examination post treatment, MGD patients remained symptomatic. IVCM revealed increased immune cells in the palpebral conjunctiva (refractory MGD EIC=592.6±110.1 cells/mm 2 ; untreated MGD EIC=522.6±104.7 cells/mm 2 , P =0.69; responsive MGD EIC=194.9±119.4 cells/mm 2 , P
ISSN:0950-222X
1476-5454
DOI:10.1038/eye.2015.103