Severity of Sjogren's Syndrome Keratoconjunctivitis Sicca Increases with Increased Percentage of Conjunctival Antigen-Presenting Cells

This study investigated the relationship between clinical severity and percentage of conjunctival antigen-presenting cells (APCs) in Sjogren's syndrome (SS)-associated keratoconjunctivitis sicca (KCS). KCS clinical severity was based on symptom severity, tear volume, tear break-up time, and ocular surface dye staining. Conjunctival goblet cell density (GCD) was measured in periodic acid Schiff (PAS)-stained membranes. Conjunctival cells obtained by impression cytology were used for flow cytometry to measure percentages of CD45(+) HLA-DR+ APCs and mature CD11c(+)CD86(+) dendritic cells (DCs). Compared to normal conjunctiva, the percentages of HLA-DR+ and CD11c+ CD86(+) cells were higher in the conjunctiva of the KCS group (p < 0.05). The percentage of CD45(+) HLA-DR+ cells positively correlated with clinical severity (r = 0.71, p < 0.05) and negatively correlated with GCD (r = 0.61, p < 0.05). Clinical severity also negatively correlated with GCD (r = 0.54, p < 0.05). These findings indicate that a higher percentage of APCs and mature DCs in the conjunctiva is associated with more severe KCS in SS. These APCs may contribute to the generation of the pathogenic Th1 cells that cause goblet cell loss in KCS.