To evaluate corneal endothelial cell density (ECD) in patients with dry eye disease (DED) compared to an age-matched control group.

Cross-sectional, controlled study.

This study included 90 eyes of 45 patients with moderate to severe DED (aged 53.7 ± 9.8 years) and 30 eyes of 15 normal controls (aged 50.7 ± 9.8 years). All subjects had a complete ophthalmic evaluation including symptom assessment using the Ocular Surface Disease Index (OSDI) and corneal fluorescein staining. In addition, laser scanning in vivo confocal microscopy was performed to measure the density of the following parameters in the central cornea: endothelial cells, subbasal nerves, and subbasal immune dendritic cells.

Corneal ECD was significantly lower in the DED group (2595.8 ± 356.1 cells/mm²) than in the control group (2812.7 ± 395.2 cells/mm², P = .046). The DED group showed significantly lower corneal subbasal nerve density (17.1 ± 6.9 mm/mm²) compared to the control group (24.7 ± 4.4 mm/mm², P < .001). Dendritic cell density was significantly higher in the DED group than in the controls (111.7 ± 137.3 vs 32.0 ± 24.4 cells/mm², respectively, P = .002). There were statistically significant correlations between corneal ECD and dry eye severity parameters including the OSDI score (r_s = −0.26, P = .03), and corneal fluorescein staining (r_s = −0.28, P = .008).

There is a significant reduction in corneal ECD in DED that correlates with clinical severity of the disease.