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PURPOSE To study clinical and in vivo laser scanning confocal microscopy (LSCM) ocular surface findings in stable, medically controlled primary open-angle glaucoma (MCPOAG) patients. METHODS We recruited 100 consecutive patients with MCPOAG and 50 healthy controls. Patients had to have been treated with the same medical regimen without variation for the 18 months before enrollment and were excluded if there was a history of dry eye prior to glaucoma diagnosis. Each participant underwent ocular surface clinical and LSCM examination. RESULTS In MCPOAG patients, subbasal nerve length and tortuosity and dendritic cell density were increased compared to controls (P < 0.01), but there were no clinical abnormalities. Patients treated with preserved drugs (n = 80) had reduced tear film breakup time (P < 0.05, ANOVA), and those preserved with benzalkonium chloride (n = 72) had reduced Schirmer test values (P < 0.001). Patients (n = 50) treated with two or more drugs had increased lissamine green conjunctival staining (P < 0.001, LSD post hoc test). Patients (n = 29) treated with three or more eye drops daily had decreased Schirmer test values. Laser scanning confocal microscopy showed subbasal changes related to preservatives, type and number of drugs, and number of eye drops. CONCLUSIONS In stable MCPOAG patients without dry eye history, the ocular surface changes due to antiglaucoma medications are mostly subclinical. Active ingredients, preservatives, number of concomitant drugs, and number of eye drops instilled per day are all elements that can induce ocular surface changes. The clinical relevance of these changes remains to be determined.

To analyze in vivo corneal morphology and ultrastructural features in patients with classic Ehlers-Danlos syndrome (EDS).Fifty patients with classic EDS and 50 age- and sex-matched control subjects were studied. A clinical evaluation was made with the Ocular Surface Disease Index (OSDI) questionnaire and a complete ophthalmic examination, including assessment of the best-corrected visual acuity and refraction, slit-lamp biomicroscopy, tear break-up time, intraocular pressure, Schirmer test without topical anesthesia, and corneal diameter. Scheimpflug camera topography and in vivo confocal microscopy (IVCM) were used to investigate corneal morphology and corneal ultrastructural features respectively.Classic EDS patients, compared to controls, had thinner and steeper corneas (P0.001 and P0.05, respectively; independent samples t-test). IVCM showed thinner stromas, lower keratocyte densities (P0.001), increased applanation-related stromal folds (P0.001; Mann-Whitney U test), and increased endothelial hyperreflective dots (P0.05) in these patients. The study group also had increased symptoms (OSDI score: P0.01, independent samples t-test) and signs (tear break-up time and Schirmer test: P0.001 and P0.05, respectively) of tear film dysfunction.Patients with classic EDS had macro- and microstructural changes of the cornea, which is a target tissue of the disease. These findings should be considered to optimize clinical management of these patients and to evaluate the opportunity of adding ocular findings to the classic EDS diagnostic criteria.

Efron, N., Jones, L., Bron, A. J., Knop, E., Arita, R., Barabino, S., … Markoulli, M. (2013). The TFOS International Workshop on Contact Lens Discomfort: Report of the Contact Lens Interactions With the Ocular Surface and Adnexa Subcommittee. Investigative Opthalmology & Visual Science, 54(11), TFOS98. https://doi.org/10.1167/iovs.13-13187

PURPOSE. To analyze the in vivo morphology of corneal cells and nerves in patients with rheumatoid arthritis (RA), with or without secondary Sjogren's syndrome (SSII), and to investi- gate the correlations between corneal alterations and RA activ- ity. METHODS. Fifty patients with RA and 30 age- and gender- matched control subjects were studied. SSII was diagnosed according to the American-European Consensus Group crite- ria, and RA activity was evaluated by the Lansbury index (LI). Confocal microscopy was used to investigate corneal thick- ness, the number of epithelial and stromal cells, and keratocyte hyperreflectivity. In addition, the sub-basal plexus was assessed for the number, tortuosity, and reflectivity of the nerve fibers and the presence of beadlike formations. RESULTS. Sixteen percent of patients with RA also had SSII. Between the SSII and non-SSII groups, no significant differ- ences were found in the LI or in the clinical and confocal variables. Significant differences were present between pa- tients with RA and control subjects for all the variables studied except nerve reflectivity. In patients with RA with and without SSII, LI correlated significantly with the number of beadlike formations and the number of hyperreflective, activated ker- atocytes. CONCLUSIONS. Confocal microscopy of patients with RA showed several changes in corneal cells and nerves. The number of beadlike formations and the number of activated keratocytes could be interpreted as confocal signs of ocular surface disease activity. These correlations with the index of systemic disease activity, LI, may provide insight regarding the pathogenic mechanisms of dry eye in patients with RA. (Invest Ophthal- mol Vis Sci. 2008;49:560 -564) DOI:10.1167/iovs.07-0893 In this study we used confocal microscopy to analyze the corneal morphologic alterations in patients with RA, with or without SSII. We evaluated potential correlations between oc- ular surface manifestations of RA and the activity of systemic RA. These correlations are particularly interesting, because recent reports suggest that there are profound etiologic and pathogenic differences between KCS in patients with RA with SSII and patients with RA without SSII, though they lack man- ifest differences in the clinical indicators. 5,9 Confocal micros- copy appears to be an essential instrument for exploring the nature of corneal alterations in such patients, as it provides quick, noninvasive, in vivo microstructural evaluations.