BACKGROUNDDry eye patients suffer from all kinds of symptoms. Sometimes, the clinical signs evaluation does not disclose any obvious difference in routine examination; in vivo confocal microscopy (IVCM) is a powerful tool for ocular surface disease. This study aimed to clarify meibomian gland (MG) alterations in dry eye patients with different symptoms and to compare the findings using IVCM.

METHODSA total of sixty patients were recruited, all subjected to Ocular Surface Disease Index (OSDI) and Salisbury Eye Evaluation Questionnaire (SEEQ), and questionnaires for the assessment of dry eye symptoms before clinical sign examinations were given to the patients. Finally, IVCM was applied to observe MG's structure. Statistical analysis was performed using the t-test, Mann-Whitney U-test and Spearman correlation analysis. The differences were statistically significant when P< 0.05.

RESULTSIn the severe symptom group, OSDI and SEEQ scores were significantly higher (P< 0.05) compared with the mild symptoms group. All other clinical sign examinations had no statistical difference in the two groups (P> 0.05). However, all the IVCM-observed data showed that patients with severe symptoms had more significant fibrosis in MG (acinar unit area 691.87 ± 182.01 μm2 for the severe, 992.17 ± 170.84 μm2 for the mild; P< 0.05) and severer decrease in the size of MG acinar units than those observed in patients with mild symptoms (MG acinar unit density [MGAUD] 70.08 ± 18.78 glands/mm2, MG acinar unit longest diameter [MGALD] 51.50 ± 15.51 μm, MG acinar unit shortest diameter [MGASD] 20.30 ± 11.85 μm for the severe, MGAUD 89.53 ± 39.88 glands/mm2, MGALD 81.57 ± 21.14 μm, MGASD 42.37 ± 14.55 μm for the mild;P< 0.05). Dry eye symptoms were negatively correlated with MG confocal microscopic parameters and positively correlated with conjunctival inflammatory cells and Langerhans cells (P< 0.05).

CONCLUSIONSIVCM application provides a strong support to differentiate dry eye patients with different symptoms: meibomian gland dysfunction (MGD) plays a pivotal role in dry eye aggravation, and using IVCM to observe MG fibrosis, changes in size and density of MG as well as status of inflammation cells can help not only correctly diagnose the type and severity of dry eye, but also possibly prognosticate in routine eye examination in the occurrence of MGD.

Adult ; Aged ; Dry Eye Syndromes ; diagnosis ; physiopathology ; Eyelid Diseases ; diagnosis ; physiopathology ; Female ; Humans ; Male ; Meibomian Glands ; pathology ; physiopathology ; Microscopy, Confocal ; methods ; Middle Aged

PURPOSE: To investigate the association between dry eye syndrome (DE) and serum levels of interleukin (IL)-17 in patients with systemic immune-mediated diseases. METHODS: IL-17 and IL-23 levels were measured in the sera of patients whose tear production was <5 mm on the Schirmer test. Subjects included patients with chronic graft-versus-host disease (GVHD), rheumatoid arthritis (RA), Sjogren's syndrome (SS), systemic lupus erythematosus (SLE), and no systemic disease. Corneal/conjunctival fluorescein staining was scored and the correlation between the score and the IL-17 level was evaluated. RESULTS: A strong correlation existed between IL-17 level and the type of systemic disease. IL-17 was significantly elevated in patients with chronic GVHD compared to those with RA and SS. IL-17 was not detectable in patients with SLE or in those without systemic disease. IL-23 was not detected in any of the subjects. IL-17 was significantly increased in patients with high fluorescein staining scores. CONCLUSIONS: Our data suggest that IL-17 is involved in the pathogenesis of DE in patients with systemic immune-mediated diseases.
Adult ; Biological Markers/blood ; Conjunctiva/*pathology ; Diagnosis, Differential ; Dry Eye Syndromes/*blood/diagnosis/immunology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; *Immunity, Innate ; Interleukin-17/*blood ; Male ; Middle Aged

PURPOSE: To establish the strength of the association between routine tear function tests and conjunctival impression cytology (CIC) and to determine whether they simulate the morphological and cytological changes that occur on the ocular surface in dry eye. What are the sensitivity, specificity and positive predictive values of these tests when CIC is considered the gold standard? METHODS: The tear film profile included tear film break up time (TBUT), Schirmer's-1, Rose Bengal scores (RBS), and impression cytology. CIC samples were obtained from the inferior bulbar conjunctiva and stained with periodic acid-Schiff and counter stained with hematoxylin and eosin. RESULTS: The mean Schirmer's value was 11.66 +/- 5.90 in patients and 17.17 +/- 2.97 in controls (p < 0.001). The mean TBUT in participants was 8.88 +/- 3.54 and 13.53 +/- 2.12 in controls (p < 0.001). Patients had a mean goblet cell density (GCD) of 490 +/- 213, while the value for controls was 1,462 +/- 661 (p < 0.001). Abnormal CIC was observed in 46.7% cases of dry eye and in 32.8% of controls. The correlation coefficient (L) for Schirmer's was 0.2 and 0.24 for participants and controls, respectively, while TBUT values were 0.26 and 0.38, RBS were 0.5 and 0.5, and GCD was 0.8 and 0.6 in cases and controls, respectively. CONCLUSIONS: GCD, RBS, and TBUT were better predictors of morphological and cytological changes in the conjunctiva than Schirmer's in dry eye syndrome. The sensitivity of tear function tests in diagnosing dry eye was TBUT > Schirmer's > RBS, and the specificity was Schirmer's > TBUT > RBS in decreasing order when CIC was considered the gold standard.
Adolescent ; Adult ; Case-Control Studies ; Child ; Conjunctiva/pathology ; Diagnostic Techniques, Ophthalmological/*standards ; Dry Eye Syndromes/*diagnosis/*pathology ; Eosine Yellowish-(YS)/diagnostic use ; Female ; Goblet Cells/pathology ; Hematoxylin/diagnostic use ; Humans ; Male ; Middle Aged ; Ophthalmology/*standards ; Periodic Acid-Schiff Reaction/standards ; Predictive Value of Tests ; Rose Bengal/diagnostic use ; Sensitivity and Specificity ; *Tears ; Young Adult