In-vivo confocal microscopy of the ocular surface: ocular allergy and dry eye

To summarize recent studies on in-vivo confocal microscopy (IVCM) findings in ocular allergy and dry eye disease (DED), highlighting the role of IVCM in the advancement of knowledge of these diseases.

IVCM provided new data on ocular surface changes in both ocular allergy and DED. Corneal and conjunctival epithelial and inflammatory cells, corneal nerves, and Meibomian glands showed peculiar patterns of abnormalities, not easily discernable with current clinical exams in these two diseases and their subtypes. At present, small sample size of researches, and poor standardization and evidence of image analysis and interpretation are the most challenging issues.

Ocular allergy and DED are common and increasing healthcare problems, and need better understanding of pathogenesis and natural history, more reliable endpoints, and more tailored diagnostic and therapeutic approaches. IVCM allows quick, noninvasive, steady-state respectful examination of the ocular surface at cellular level to be performed and has potential to be used in the future as a biomarker and to contribute to optimize the tailored management of these diseases.