In Vivo Confocal Microscopy in Healthy Conjunctiva, Conjunctivitis, and Conjunctival Tumors

Abstract

■ In vivo confocal microscopy allows the visualization of the ocular surface at the cellular level

■ With near infra-red laser scanning in vivo confocal microscopy, opaque structures such as the conjunctiva and the lid margin can be scanned in addition to the transparent cornea

■ This new technique does not only permit imaging of the known anatomy, but is also able to disclose specific signs in conjunctival inflammation. It allows the differentiation and documentation of papillary and follicular conjunctivitis, acute and chronic inflammation, cicatrization as well as granuloma formation

■ Benign and malignant tumors of the conjunctiva show typical features under in vivo confocal microscopy, which may facilitate decision-making and biopsy in these patients

■ Atypical epithelial cells may be demonstrated in conjunctival intraepithelial neoplasia

■ Melanocytic lesions of the conjunctiva can be clearly differentiated, and the diagnosis of melanoma can be established with high sensitivity and specificity by an experienced examiner

■ However, due to limited knowledge in the field and a small scanning area, in vivo confocal microscopy is no substitute for the gold standard, histology, and a biopsy is required in clinically or in vivo microscopically suspect lesions of the conjunctiva