Monday, January 02, 2006

Pathology of Dry Eye Disease

Histopathology of the human corneal surface in dry eye disease.
All of the current studies cite Sjogren’s original work from 1933 in which he shows multiple photographs from a single autopsy eye of unstated post mortem time that features pathologic changes of epithelial bullae, denudation and thinning. Incredibly, only a single case report exists as to the histology of the human cornea in early dry eye disease by Sjogren in 1933. Sjogren showed multiple photomicrographs from a single cornea of one autopsied patient. The findings of epithelial denudation, epithelial thinning and epithelial bullae are featured. Sjogren’s findings have a striking similarity to bullous keratopathy that may occur for a number of reasons. The patients with bullous keratopathy have similar symptoms as those of dry eye patient. In dry eye disease, particularly meibomian gland dysfunction, the epithelial surface is frequently altered by punctate erosive defects (McCulley 1982). Indeed, the objective criteria for the clinical diagnosis of dry eye disease include the presence of epithelial defects as seen by fluorescein staining and abnormal epithelial cells as indicated by Rose Bengal staining of the cornea (Nichols 2004, McCulley 1982, Sharma 1993, Doane 1994, Golding 1997, Tseng 1995), 64, 67). There is no information on Bowman’s layer abnormalities in early dry eye disease because it cannot be visualized by slit lamp examination and it's resolution is poor with confocal laser microscopy.
The histopathology of the conjunctiva is much better delineated. In Sjogren's syndrome, Koufakis et al. IOVS 2006 have demonstrated a reduction in the number of microvilli in the conjunctiva, a diminution in the height/width ratio, reduced width of microvilli and fewer secretory granules within the apical epithelium compared to controls. These findings may be secondary to the process but nonetheless document an abnormal surface in patient with Sjogren's syndrome.

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