In Vivo Findings of the Bulbar/Palpebral Conjunctiva and Presumed Meibomian Glands by Laser Scanning Confocal Microscopy

Kobayashi, Akira; Yoshita, Tsuyoshi; Sugiyama, Kazuhisa

doi:10.1097/01.ico.0000160976.88824.2b

Cited by 88 publications

(67 citation statements)

References 10 publications

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“…Images were selected from LSCM scans that included GCs identified according to the following features: cell size of 25 to 30 lm in diameter, 16,17 hyperreflective, 18 bigger than surrounding cells, 19 round to oval in shape, 20 and sometimes with a visible nucleus. 2 Conjunctival Impression Cytology.…”

Section: Goblet Cell Densitymentioning

confidence: 99%

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Colorado

Alzahrani

Pritchard

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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Citation: Colorado LH, Alzahrani Y, Pritchard N, Efron N. Time course of changes in goblet cell density in symptomatic and asymptomatic contact lens wearers. Invest Ophthalmol Vis Sci. 2016;57:288857: -289457: . DOI:10.1167 PURPOSE. To investigate longitudinal changes in goblet cell density (GCD) in contact lens (CL) wearers who do and do not develop symptoms of dry eye (DE). METHODS.Sixty healthy individuals fitted with daily disposable hydrogel CLs and 23 agebalanced non-CL-wearing controls underwent assessment using the 5-item dry eye questionnaire, noninvasive tear film break-up time measurement, ocular surface assessment, and phenol red thread test evaluation. Laser scanning confocal microscopy (LSCM) and conjunctival impression cytology (CIC) were used to assess GCD at baseline and follow-up visits at 1 week and 1 and 6 months. After 1 week, all CL wearers were categorized as those who were and were not symptomatic based on responses to the CL dry eye questionnaire-8 (CLDEQ-8). A linear mixed-model was used to examine changes in GCD over time. RESULTS.The global mean GCD of the 83 participants at baseline (before CL wear) was 476 6 41 and 467 6 52 cells/mm 2 using LSCM and CIC, respectively. After 6 months of CL wear, GCD was reduced by approximately 13% and 29% in asymptomatic (N ¼ 29) and symptomatic (N ¼ 17) CL wearers (all P < 0.001), respectively, observed with both LSCM and CIC.CONCLUSIONS. Contact lens wear induces a reduction of GCD over 6 months, which is exacerbated in those with DE symptoms. Either LSCM or CIC can be used to assess GCD in the conjunctiva.Keywords: contact lens wear, symptoms, dry eye, conjunctival goblet cells C onjunctival goblet cells (GCs) are secretory epithelial cells responsible for the production of the mucinous component of the tear film to support the integrity of the ocular surface. A decreased number of GCs is common in conditions of dry eye (DE), 1,2 which is described as a multifactorial disorder causing damage to the ocular surface. 3 Goblet cells may also contribute to the ocular immune response, as they have been shown to secrete cytokines and modulate dendritic cell phenotype. 4 The presence of mucin during contact lens wear (CLW) promotes surface wettability and tolerance to CLW. However, a lack of mucin discharge onto the ocular surface can cause the patient to experience symptoms such as itching, burning, reduction of visual acuity, and dryness. 5Contact lens (CL) wearers frequently report symptoms of dryness but the reason for this is not completely understood. The resulting discomfort may cause CL wearers to reduce wearing time, or cease lens wear altogether. Indeed, up to 50% of wearers will discontinue CLW permanently due to DE symptoms. 6 It is therefore important to understand whether CLW causes a reduction in GCD in those who are introduced to CLW and to determine the link between GCD and DE symptoms related to CLW.Reports of the impact of CLW on conjunctival GCD are equivocal, perhaps as a result of methodologic differences in using conjunctival impr...

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Section: Goblet Cell Densitymentioning

confidence: 99%

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Colorado

Alzahrani

Pritchard

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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“…In comparison to IVCM, meibography is faster and the meibographs are quicker to analyze, but they are limited in the depth of information provided. IVCM on the other hand provides ultrastructural information about both the immune status of the palpebral conjunctiva and meibomian glands and the anatomical dimensions of these glands and ducts [36,[66][67][68]. Recently, the role of inflammation in dry eye disease and MGD has received particular interest [15,69].…”

Section: Discussionmentioning

confidence: 99%

Objective Metrics of Ocular Surface Disease in Contact Lens Wearers: Meibography

Qazi

Hamrah

2015

Curr Ophthalmol Rep

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Dry eye symptoms are very prevalent in contact lens wearers and are most commonly attributed to evaporative dry eye (EDE) due to alterations in the quality of the pre-lens tear film lipids. Meibomian gland dysfunction (MGD), the most common cause of EDE, may result in contact lens-associated dry eye and ultimately to intolerance to contact lens wear. Thus, a thorough assessment of meibomian glands and the eyelid margin prior to and during contact lens wear may ensure continuous contact lens tolerance and the maintenance of a healthy ocular surface. Since meibomian glands are not overtly visible on slit-lamp biomicroscopy, imaging methods such as infrared meibography could play an important role in the evaluation of meibomian gland health. This review discusses the most pertinent advances in infrared meibography and its application to contact lens wearers, with a focus on the utility of quantitative imaging methods in the evaluation of meibomian glands.

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“…IVCM has allowed visualization of cellular detail in the evaluation of both the conjunctiva 23,24,27,28 and cornea, 29,30 which is comparable to and correlates strongly with ex vivo histological techniques such as immunohistochemistry 31 and conjunctival impression cytology. 32,33 This provision made by IVCM has allowed clinical research to spearhead, where previously obtaining * * epithelium epithelium stroma stroma epithelium epithelium stroma stroma stroma stroma air Figure 4 Qualitative features of the palpebral conjunctiva and associated glands in MGD-associated persistent dry eye symptoms using in vivo confocal microscopy (IVCM).…”

Section: Discussionmentioning

confidence: 99%

“…32 Since the initial work on the use of IVCM in detection of immune cells in the normal palpebral conjunctiva and identification of presumed meibomian glands, 27 more recent research in MGD and DED has allowed for the development of quantifiable parameters to assess and monitor both physiologic and disease states, 23,25,35 including metrics to diagnose MGD such as acinar density. 25 Our work presents an extension of the many applications of IVCM, specifically to detect clinically non-apparent palpebral conjunctival inflammation in MGD patients that suffer from refractory symptoms of discomfort, dry eye, and photophobia, despite objective improvement on clinical tests (TBUT, MGYLS) with an unremarkable slit-lamp examination.…”

Section: Discussionmentioning

confidence: 99%

In vivo detection of clinically non-apparent ocular surface inflammation in patients with meibomian gland dysfunction-associated refractory dry eye symptoms: a pilot study

Qazi

Kheirkhah

Blackie

et al. 2015

Eye

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Purpose The utility of in vivo confocal microscopy (IVCM) in the investigation of palpebral conjunctival and corneal inflammation in patients with meibomian gland dysfunction (MGD)-associated refractory dry eye symptoms following gland expression, despite objective clinical improvement. Methods A retrospective, observational pilot study was conducted evaluating five patients with MGD-associated refractory dry eye symptoms and three control groups: symptomatic untreated MGD patients (n = 3), treatment-responsive MGD patients with improved symptoms (n = 3) and asymptomatic healthy normals (n = 11). Ocular surface disease index (OSDI) scores, tear break-up time (TBUT), the number of meibomian glands yielding liquid secretion (MGYLS), palpebral conjunctival epithelial and substantia propria immune cell (EIC, SIC), and corneal dendritic cell (DC) densities were measured. Results Despite clinical improvement (TBUT: 6.4 ± 1.2 s to 10.1 ± 2.1 s, P = 0.03; MGYLS: 3.5 ± 0.8 glands to 7.0 ± 1.1 glands, P = 0.13) and a normal clinical examination post treatment, MGD patients remained symptomatic. IVCM revealed increased immune cells in the palpebral conjunctiva (refractory MGD EIC = 592.6 ± 110.1 cells/ mm 2 ; untreated MGD EIC = 522.6 ± 104.7 cells/mm 2 , P = 0.69; responsive MGD EIC = 194.9 ± 119.4 cells/mm 2 , Po0.01; normals EIC = 123.7 ± 19.2 cells/mm 2 , Po 0.001), but not the cornea (refractory MGD DC = 60.9 ± 28.3 cells/mm 2 ; normals DC = 25.9 ± 6.3 cells/mm 2 ; P = 0.43). EIC did not correlate with TBUT (R s = − 0.26, P = 0.33). OSDI scores correlated with both EIC (R s = 0.76, Po0.001) and TBUT (R s = − 0.69, Po0.01) but not SIC. Intraglandular immune cells were also seen. Conclusion MGD-associated refractory symptoms and the symptom-sign disparity may be explained by clinically non-apparent, active inflammation of the palpebral conjunctiva as detected by IVCM. These patients may benefit from anti-inflammatory therapy.

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In Vivo Findings of the Bulbar/Palpebral Conjunctiva and Presumed Meibomian Glands by Laser Scanning Confocal Microscopy

Cited by 88 publications

References 10 publications

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Time Course of Changes in Goblet Cell Density in Symptomatic and Asymptomatic Contact Lens Wearers

Objective Metrics of Ocular Surface Disease in Contact Lens Wearers: Meibography

In vivo detection of clinically non-apparent ocular surface inflammation in patients with meibomian gland dysfunction-associated refractory dry eye symptoms: a pilot study

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