Abstract:

Objective To observe and analyze the anatomical structure of the area with lid wiper using confocal microscopy in patients with dry eye. Design Prospective case series. Participants 90 cases of dry eye patients and 79 cases of normal control group in Beijing Tongren Hospital from January to September 2017 were collected. Methods A test paper containing sodium fluorescein and Liz amine green dyeing were used to dye the eyelid wiper areas and classify the epithelial lesions in normal and dry eye group, then the confocal microscopy was applicated to measure the depth of lid wiper epitheliopathy, and the number of inflammatory cells and vasculars under epithelial, collecting photos and analysis. Main Outcome Measures The classification of lid wiper epitheliopathy, the number of inflammatory cells and vasculars under epithelial. Results There were 51 cases (64.5%) with lid wiper epitheliopathy in normal group, and 86 cases (95.6%) in the dry eye group (χ2=24.35, P<0.005). In the normal group, 16 cases had no lid wiper epitheliopathy, and 26 cases without high reflective material, and 10 cases with normal subcortical vascular. In the dry eye group, 5 cases had no lid wiper epitheliopathy, and 20 cases without high reflective material, and 19 cases of normal subcortical vessels. There was a statistically significant difference between the two groups in the lesion depth of upper and lower lid wiper epitheliopathy (t=2.35, 2.20，P<0.05). In the dry eye group , the lesion depth of upper lid wiper epitheliopathy and the number of inflammatory cells were positively correlated with the corneal staining scores (r=0.333, 0.304，P<0.05). Significantly negative correlation was observed between the lesion depth of upper lid wiper epitheliopathy and Schiemer I numerical in the dry eye group (r=-0.272，P=0.050). The number of subcortical vasculars was positively correlated with the upper and lower lipid layer score (r=0.326, 0.497, P<0.05). The lesion depth of lower eyelid wiper epitheliopathy was positively correlated with the classification of lid wiper epitheliopathy (r=0.616, P=0.025). Conclusion Confocal microscopy can be used to observe in vivo the histology changes of lid wiper in dry eyes. There was a significant correlation between the degree of lid wiper epitheliopathy and the severity of dry eye in the dry eye patients.

Key words: dry eye, lid wiper epitheliopathy, confocal microscopy