In vivo confocal microscopy (IVCM) is a sensitive imaging tool for detecting dry eye-associated subclinical inflammation. Studies have previously shown that IVCM provides an in vivo metric to measure inflammatory changes in the central cornea. The objective of the current study is to assess inflammatory response changes in the peripheral cornea and the conjunctiva by analyzing epithelial immune cell density and morphology in these areas and then correlating the IVCM findings to clinical signs and symptoms to establish novel objective imaging biomarkers.

For Dry Eye Disease Participants

Inclusion Criteria:

• Age >18
• Ability to consent to study
• Symptoms of dry eye disease for at least 6 months, such foreign body sensation, burning, stinging, light sensitivity
• Positive vital dye staining of the cornea
• At least one of the following objective signs: (Schirmer I <10 mm at 5 minutes), decreased (<0.2 mm) tear meniscus, decreased tear breakup time (TBUT) of <10 seconds, positive vital dye staining of the conjunctiva

For Age-Match Controls

Inclusion Criteria:

• Between the ages of 18-89
• The ability to provide informed consent for study inclusion
• Clear, healthy cornea
• Normal tear meniscus (> 0.3 mm)

For Dry Eye Disease Participants

Exclusion Criteria:

• History of contact lens wear in the past 3 months
• History of ocular surgery in the past 6 months
• Active ocular allergies
• History of ocular infection in the past 3 months
• History of diabetes
• History of topical or systemic anti-inflammatory therapy in the past 1 month

For Age-Match Controls

Exclusion Criteria:

• History of ocular or eyelid surgery within the past 12 months
• History of herpetic or other infectious keratitis or other inflammatory eye disease
• History of any other acute ocular disease
• Current use of topical medications (not including artificial tears)
• Current use of contact lenses
• History of ocular carcinoma or any recent ocular topical chemotherapy or radiotherapy
• History of cancer elsewhere in the body which is currently under systemic chemotherapy
• Current glaucoma disease requiring use of glaucoma drops
• History of Diabetes mellitus
• Current diagnosis of dry eye disease

Patients with and without Dry Eye Disease