Abstract
C-fibers are unmyelinated nerve fibers that transmit high threshold mechanical, thermal, and chemical signals that are associated with pain sensations. This review examines current literature on measuring altered peripheral nerve morphology and discusses the most relevant aspects of corneal microscopy, especially whether corneal imaging presents significant method advantages over skin biopsy. Given its relative merits, corneal confocal microscopy would seem to be a more practical and patient-centric approach than utilizing skin biopsies.
Highlights
The morphological properties of small sensory nerve fibers provide important markers of overall health of the peripheral nervous system
This paper will focus on C-fibers and briefly summarize the literature regarding anatomy of corneal innervation, present the way corneal afferent imaging may be used as a tool in the study of sensation and pain, and discuss potential benefits and utility of corneal microscopy relative to traditional skin biopsy
Skin biopsy can be used for measurements of intraepidermal nerve fiber density (IENFD) of
Summary
The morphological properties of small sensory nerve fibers provide important markers of overall health of the peripheral nervous system. The cornea is the most densely innervated structure in mammals and has been reviewed in detail elsewhere [1] It provides a number of unique features for clinical examination because it can be scanned in awake human subjects, has a well-defined anatomy in health, and can exhibit changes in both neural integrity and inflammatory cells in patients. Nerve morphology alterations in the skin and cornea have been correlated with disease condition in both the peripheral and central nervous system [6,7,8]. Corneal imaging can evaluate patients with symptoms of itching, pain, discomfort, photophobia, and intolerance to cold Both can be used to assess the health of small fibers in systemic disorders [11,12]
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