Recent in vivo confocal microscopy (IVCM) studies have provided additional insight into the etiology of dry eye syndrome (DES) and allow monitoring cellular changes by providing an objective methodology to monitor treatment efficacy, image-guided therapy may allow the opportunity of modifying treatment based on cellular changes, rather than on clinical alterations alone. This study performed to understand The usage of IVCM to confirm clinical outcomes, the Extent of the cellular response to the anti-inflammatory treatments in the subject's and the effectiveness of three eye-drops, preservative free artificial tear (Artelac), Loteprednole (Lotemax) and Cyclosporine (Lacrosporine 0.05%), in treating the inflammation associated with DES.

This prospective randomized, single-masked, clinical trial was conducted with 60 patients with DES who were randomized into 3 treatment groups. Subjects received treated for 6 weeks. IVCM of the central cornea was done at baseline and 6 weeks after treatment. Imaging parameters, Symptom (Ocular Surface Disease Index questionnaire; OSDI) and ocular surface assessments were done at baseline and post treatment visits.

Finally both Lotemax and Cyclosporine in comparison with Artelac had significant decrease in corneal subbasal dendritiform cells Density (P-Value: < 0.001). In the Cyclosporine group significant improvement of Schirmer’s test was noted. Lotemax treatment made significant decrease in OSDI scores, corneal fluorescein staining score and superficial corneal epithelial cells hyperreflectivity and a noticeable increase in Superficial corneal epithelial cells density and TBUT. Significant increase in corneal subbasal nerves length also noted.

Lotemax had more effect on cellular density and morphology and even had effect on subbasal nerve length at 6 weeks period so its effect may be continued in drug free period. Both cyclosporine and Lotemax are effective at reducing corneal inflammation in DES and are superior to artificial tears. Corneal subbasal nerve length may be a surrogate marker to quantifying ocular response to treatment.