Dry eye and corneal langerhans cells in systemic lupus erythematosus.

Miklós D Resch,László Marsovszky,László Kovács,János Németh,Attila Balog,Márta Bocskai

doi:10.1155/2015/543835

Miklós D Resch, László Marsovszky + Show 4 more

Open Access

https://doi.org/10.1155/2015/543835

Copy DOI

Abstract

Purpose. Investigation of dry eye and corneal Langerhans cells (LCs) in systemic lupus erythematosus (SLE). Methods. Prospective consecutive case series of 27 SLE patients and 27 control subjects. Dry eye was evaluated by lid-parallel conjunctival folds (LIPCOF), Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) questionnaire. In vivo investigation of corneal LCs density and morphology (LCM) was performed with confocal corneal microscopy (Heidelberg Retina Tomograph with Rostock Cornea Module). Results. Tear production and stability were pathological in SLE subjects compared to control (Schirmer: 8.45 ± 9.82 mm/5 min versus 11.67 ± 3.21 mm/5 min; TBUT: 6.86 ± 3.53 s versus 11.09 ± 3.37 s). OSDI was significantly greater in SLE patients (25.95 ± 17.92) than in controls (11.06 ± 7.18). Central LC density was greater in SLE patients (43.08 ± 48.67 cell/mm2) than in controls (20.57 ± 21.04 cell/mm2). There was no difference in the peripheral LC density (124.78 ± 165.39 versus 78.00 ± 39.51 cell/mm2). LCM was higher in SLE patients in the centre (1.43 ± 0.79) and in the periphery (2.89 ± 0.42) compared to controls (centre: 1.00 ± 0.69, periphery: 2.35 ± 0.54). Conclusions. Significant changes in dry eye parameters and marked increase of central LCs could be demonstrated in SLE patients. SLE alters not only the LC density but also the morphology, modifies corneal homeostasis, and might contribute to the development of dry eye.

Highlights

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease of unknown etiology
SLE patients with secondary Sjogren’s syndrome diagnosed according to the 2002 American-European consensus criteria for Sjogren’s syndrome were excluded from the study [4], since it has been described that Sjogren related hypolacrimation resulted in severe dry eye, which itself results in significant changes in Langerhans cells (LCs) density and morphology
We found that the central LC density was greater in SLE patients when the C-reactive protein (CRP) was above 5 mg/L, compared to control subjects, but LC number was comparable to controls in SLE patients with lower inflammatory reactions (CRP < 5 mg/L)

Summary

Introduction

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease of unknown etiology. Pathological conditions, various forms of injuries [16], or minor stimuli to the cornea (such as contact lens wear [17] or chronic use of antiglaucoma eye drops [18]) may induce LCs to undergo maturation with the formation of dendrite-like processes [17, 18]. Our team has recently demonstrated the presence of activated LCs in the central cornea of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients [19, 20] This drove our attention to further investigate corneal LCs and Journal of Ophthalmology the dry eye related parameters in another systemic inflammatory disease, that is, SLE.

Methods

Results

Discussion

Conflict of Interests