Microstructural proofs of dry eye changes

Abstract

PURPOSE : To evaluate and to demonstrate the morphological changes of the Meibomian glands in patients with evaporative `dry eye` compared to normal subjects by in vivo laser scanning confocal microscopy and to correlate these changes to the clinical observations and tear functions. DESIGN : Prospective over controlled case series METHODS : The study was based on trans-tarsal images (optical slices) of 30 normal and 19 diseased lids (patients with subjective complaints and objective symptoms of evaporative `dry eye`). Each participant was examined by in vivo laser scanning confocal microscopy (HRTII Rostock corneal module). The results were compared to histological findings of normal or pathologically changed Meibomian glands. RESULTS : Patients with evaporative `dry eye` presented with destructive changes of the Meibomian glands as follows: occlusion of the lumen, impaired morphology of the acines, lack of normal structure and infiltration with inflammatory cells. Reported ocular surface and tear function abnormalities were correlated to the Meibomian glands dysfunction. In all cases the lid hygiene and anti-inflammatory treatment demonstrated tendency to restoration of the structure. CONCLUSION : In vivo laser scanning confocal microscopy can effectively demonstrate the morphological changes of the Meibomian glands in patients with evaporative dry eye symptoms. This new noninvasive technology is useful as a supplementary diagnostic tool for in vivo assessment of the histopathology of many ocular surface disorders and monitoring of the therapeutic effect in patients with Meibomian glands dysfunction. Glandular acinar density and acinar unit diameter seemed to be promising new parameters of Meibomian glands in vivo confocal microscopy. The examination has the potential to change the evaporative dry eye treatment approach.