Corneal Dendritic Cell Density Is Associated with Subbasal Nerve Plexus Features, Ocular Surface Disease Index, and Serum Vitamin D in Evaporative Dry Eye Disease.

Rohit Shetty,Swaminathan Sethu,Rushad Shroff,Aarti Agrawal,Kalyani Deshpande,Arkasubhra Ghosh,Rashmi Deshmukh

doi:10.1155/2016/4369750

Rohit Shetty, Swaminathan Sethu + Show 5 more

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https://doi.org/10.1155/2016/4369750

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Journal: BioMed research international	Publication Date: Jan 1, 2016
Citations: 65	License type: CC BY 4.0

Affiliation: Narayana Nethralaya

Abstract

Dry eye disease (DED) has evolved into a major public health concern with ocular discomfort and pain being responsible for significant morbidity associated with DED. However, the etiopathological factors contributing to ocular pain associated with DED are not well understood. The current IVCM based study investigated the association between corneal dendritic cell density (DCD), corneal subbasal nerve plexus (SBNP) features, and serum vitamin D and symptoms of evaporative dry eye (EDE). The study included age and sex matched 52 EDE patients and 43 heathy controls. A significant increase in the OSDI scores (discomfort subscale) was observed between EDE (median, 20.8) and control (median, 4.2) cohorts (P < 0.001). Similarly, an increase in DCD was observed between EDE (median, 48.1 cells/mm2) patients and controls (median, 5.6 cells/mm2) (P < 0.001). A significant decrease in SBNP features (corneal nerve fiber length, fiber density, fiber width, total branch density, nerve branch density, and fiber area) was observed in EDE patients with OSDI score >23 (P < 0.05). A positive correlation was observed between DCD and OSDI discomfort subscale (r = 0.348; P < 0.0003) and SBNP features. An inverse correlation was observed between vitamin D and OSDI scores (r = −0.332; P = 0.0095) and DCD with dendritic processes (r = −0.322; P = 0.0122). The findings implicate DCD, SBNP features, and vitamin D with EDE symptoms.

Highlights

Dry eye disease (DED) is one of the common disorders of the eye with an estimated prevalence of 5.5%–33.7% worldwide [1]
Informed consent of study subjects was obtained at the time of enrollment. The subjects for this cross-sectional study to investigate the association between symptoms severity and corneal dendritic cell density and corneal subbasal nerve plexus changes using in vivo confocal microscopy (IVCM) in evaporative dry eye (EDE) were selected from patients who presented to the Cornea Clinic at Narayana Nethralaya, Bangalore, India
Total ocular surface disease index (OSDI) scores including discomfort- and vision-related OSDI subscales were observed to be significantly higher in the EDE cohort (Table 1(a))

Summary

Introduction

Dry eye disease (DED) is one of the common disorders of the eye with an estimated prevalence of 5.5%–33.7% worldwide [1]. The hallmarks of DED include discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased tear film osmolarity and inflammation of the ocular surface [2]. There has been widespread interest in understanding the disease and developing new treatment modalities for combating the ocular morbidity caused by it, especially the pain and discomfort associated with DED. The source of ocular discomfort or pain in DED cannot solely be explained by tear film metrics suggesting the role of other factors in causation of symptoms. Pain associated with dry eye has been described as neuropathic pain [5,6,7] and there have been emerging reports regarding dysfunctional ocular somatosensory nerves including the subbasal nerve plexus in ocular pain [8]

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