Dendritiform Cells Found in Central Cornea by In-Vivo Confocal Microscopy in a Patient with Mixed Bacterial Keratitis

Purpose: To report the in-vivo confocal microscopic findings of dendritiform cells in the central corneal epithelial layer in a case of mixed bacterial keratitis associated with severe immunologic reaction. Design: Observational case report. Methods: A 25-year-old male suffered from contact lens-related mixed bacterial keratitis with a dense eccentric immune ring. In-vivo confocal microscopy was performed to study the different layers of the central and peripheral cornea in the lesion and the fellow eye. Results: Several dendritiform cells were found in the basal and superficial epithelial layers of the central cornea in the lesion eye, which was also the area of the dense immune ring formation. No such cells could be identified in the fellow eye or the unaffected area of the lesion eye. Conclusion: Corneal dendritiform cells, possibly dendritic or Langerhans cells, can be identified in severe corneal immunologic conditions using in-vivo confocal microscopy. The role of these cells in ocular immunity is interesting and needs further clarification.