In vivo confocal microscopy of conjunctival goblet cells in patients with Sjogren's syndrome dry eye

Background To study the morphology and the density of conjunctival goblet cells (GC) in patients with Sjogren's syndrome dry eye with in vivo laser scanning confocal microscopy (LSCM), and to explore its correlation with the GC density detected by impression cytology. Methods A total of 43 Sjogren's syndrome dry eye patients were recruited. All were required to fill in the Ocular Surface Disease Index Questionnaires. The tear break-up time was measured, followed by corneal fluorescein staining examination and Schirmer I test. The images of conjunctiva were taken by the Heidelberg retina tomography (HRT-II)/Rostock cornea module. Finally, the specimens for impression cytology were obtained. SPSS V. 13.0 software was used to analyse the data. Results Tear film function test showed that all patients had moderate to severe dry eye. The GC in LSCM images was characterised as a large hyper-reflective oval-shape cell with relatively homogeneous brightness. Though GC density assessed by LSCM (332 +/- 137) cells/mm(2) was higher than that measured by impression cytology (200 +/- 141) cells/mm(2), they showed a significant positive correlation, p=0.908 (p<0.05). Conclusion Conjunctival GC could be easily discriminated under the LSCM. LSCM may be a valuable tool in monitoring the progress and the follow-up of patients with Sjogren's syndrome dry eye.