Conjunctiva and Limbus

IVCM can be used to non-invasively depict details of conjunctival tissue at cellular and subcellular level with superb resolution. Inflammatory cells have been shown to be elevated in different inflammatory diseases with numbers responding to treatment. Potential has also been shown in assessing conjunctival tumors, with either squamous or melanocytic origin. Goblet cell density can be assessed and is affected by different diseases including dry eye disease, glaucoma, and contact lens use. IVCM connective tissue scarring in trachoma is strongly associated with clinical grading and with scarring progression, as are the presence of dendritiform cells. IVCM has been used to demonstrate the unique structure of palisades of Vogt which is the natural habitat for stem cells at the corneoscleral limbus. Conjunctival changes including the presence of epithelial and stromal cyst, goblet cells, dendritiform cells, and stromal fiber pattern have been shown to be associated with surgical outcomes after glaucoma filtering surgery. Many advances have also been made in evaluating meibomian glands using IVCM. While research studies have shown exciting potential applications of IVCM for conjunctival diseases, there has not been a corresponding translation to clinical practice. Continued technological developments including improving image resolution, the ability to identify precise location of the scan, and deeper image acquisition in non-transparent conjunctival tissue would help to bridge this gap. This chapter outlines IVCM imaging of normal conjunctiva and limbus, and looks at how IVCM has been applied to dry eye disease, meibomian gland dysfunction, conjunctival tumors, glaucoma, allergic eye disease and trachoma.