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Updated: Apr 14, 2026
In Vivo Confocal Microscopy in the Diagnosis and Management of Dry Eye: A Focus on Imaging Protocols and Interpretation
Published on: November 11, 2025
Corneal Confocal Microscopy in Dry Eye Treated with Corticosteroids
Edoardo Villani1, Elena Garoli, Vittoria Termine
1*MD Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (all authors); Eye Clinic San Giuseppe Hospital of Milan, Milan, Italy (EV, VT, FP, PN); and Eye Clinic Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy (EG, RR).
Topical corticosteroids reduced dry eye symptoms and inflammation. Higher baseline dendritic cell density (DCD) in confocal microscopy predicted a better clinical response to treatment in dry eye patients.
Area of Science:
- Ophthalmology
- Corneal Science
- Microscopy
Background:
- Dry eye disease (DED) is a prevalent condition affecting the ocular surface.
- Inflammation plays a significant role in the pathogenesis of moderate-to-severe DED.
- Assessing in vivo corneal changes can provide insights into DED and treatment efficacy.
Purpose of the Study:
- To evaluate corneal findings using in vivo laser scanning confocal microscopy (LSCM) in patients with moderate-to-severe dry eye.
- To assess changes in corneal findings before and after topical corticosteroid treatment.
- To correlate confocal microscopy findings with clinical response to treatment.
Main Methods:
- Fifty eyes of 50 patients with moderate-to-severe DED were treated with loteprednol etabonate ophthalmic suspension 0.5% four times daily for four weeks.
- Ocular Surface Disease Index (OSDI) questionnaire, full eye examination, and central cornea LSCM were performed at baseline and follow-up.
- Baseline data were analyzed to compare patients who clinically improved versus those who did not.
Main Results:
- A significant decrease in OSDI scores and LSCM dendritic cell density (DCD) was observed post-treatment.
- Baseline DCD correlated negatively with OSDI and steroid-induced changes.
- Patients who clinically improved after steroid treatment had significantly higher baseline DCD compared to non-improved patients.
Conclusions:
- LSCM examination of DCD can detect treatment-related inflammatory changes in dry eye.
- Baseline DCD shows a previously unrecognized association with symptom improvement following topical corticosteroid treatment.
- Further research is warranted to explore the predictive value of DCD for clinical response to topical corticosteroids in DED.
