Abstract
Background: The diagnosis of trigeminal neuralgia (TN) is challenging due to the lack of objective diagnostics. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging technique, which allows quantification of corneal nerve fibers arising from the trigeminal ganglion and may allow the assessment of neurodegeneration in TN.Methods: CCM was undertaken in 11 patients with TN and 11 age-matched healthy controls. Corneal nerve fiber density (CNFD), corneal nerve branch density, corneal nerve fiber length (CNFL), corneal nerve fiber width, corneal nerve fiber area, and dendritic cell and non-dendritic cell density with or without nerve fiber contact were quantified.Results: Patients with TN had significantly lower CNFD and CNFL but no difference for any other corneal nerve or dendritic cell parameter in the ipsilateral and the contralateral cornea compared to the control group. There was no significant difference in corneal nerve and cell parameters between patients with TN with and without involvement of the ophthalmic nerve (V1) or with nerve vessel conflict.Conclusion: Corneal confocal microscopy is a rapid non-invasive imaging technique that identifies symmetrical corneal nerve loss in patients with TN.
Highlights
Trigeminal neuralgia (TN) is rare, with incidence ranging from 4.3 to 27 new cases per 100,000 people per year [1,2,3], but can markedly impair activities of daily living [4] and, in severe cases, lead to suicide [5]
We have recently shown a reduction in corneal nerve fiber density and length and an increase in Langerhans cell density in patients with burning mouth syndrome [22]
Corneal nerve fiber density (CNFD) and corneal nerve fiber length (CNFL) were significantly lower in the ipsilateral cornea of patients with TN compared to those in control subjects (Table 2, Figure 1)
Summary
Trigeminal neuralgia (TN) is rare, with incidence ranging from 4.3 to 27 new cases per 100,000 people per year [1,2,3], but can markedly impair activities of daily living [4] and, in severe cases, lead to suicide [5]. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging technique which can rapidly quantify corneal sensory nerve fibers arising from the trigeminal ganglion using automated image analysis [8, 9]. It has good diagnostic validity in diabetic neuropathy [10, 11] and has identified axonal loss in chronic inflammatory demyelinating polyneuropathy (CIDP) [12], Corneal Confocal Microscopy in Trigeminal Neuralgia hereditary sensory and autonomic neuropathy [13], Charcot– Marie–Tooth disease type 1A [14], Fabry disease [15], and idiopathic small fiber neuropathy [16]. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging technique, which allows quantification of corneal nerve fibers arising from the trigeminal ganglion and may allow the assessment of neurodegeneration in TN
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