Confocal microscopy: when is it helpful to diagnose corneal and conjunctival disease?

Abstract

In vivo confocal microscopy (IVCM) is able to demonstrate the characteristic corneal and conjunctival anatomy in vivo at the cellular level. Normal corneal innervation and cell distribution, as well as changes associated with age, contact lens wear and systemic disease such as diabetes, can be documented in vivo with this technique. IVCM is helpful to differentiate corneal dystrophies and inclusion keratopathies. Infectious agents, such as fungi and Acanthameba, may be visualized directly in the cornea in keratitis. Postsurgical applications include its use following refractive surgery, UV-crosslinking, keratoplasty and amniotic membrane transplantation to evaluate corneal wound healing. Conjunctivalization of the cornea in presumed limbal insufficiency can also be shown by IVCM. Laser scanning IVCM also allows the examination of conjunctival structures, as well as the lid margin. Thus, IVCM may help to establish a final diagnosis in atypical conjunctival inflammation and uncharacteristic conjunctival tumors. Furthermore, IVCM has proven useful in the follow-up of filtering blebs after trabeculectomy.