We hypothesized that CCM could be used to quantify corneal immune cell density to provide a rapid and objective means to assess immune alterations in patients with acute stroke.

67 acute stroke patients with minor (n=55) and moderate (n=17) stroke underwent corneal confocal microscopy (CCM) and quantification of mature and immature DC density, corneal nerve fiber density (CNFD), branch density (CNBD) and fiber length (CNFL).

Comparing patients with mild and moderate stroke to controls, CNFD (p<0.001), CNBD (p<0.001)and CNFL (p<0.001) were reduced, but there was no difference in CNFD (p=0.814), CNBD (p=0.557) and CNFL (p=n0.569), between patients with minor and moderate stroke. Mature DC’s were reduced in minor stroke (p= 0.009) with a trend for reduction in major stroke (p= 0.137)v controls. However, there was no difference in immature DC’s between minor stroke, major stroke and healthy controls (p= 0.522).

Corneal nerve loss occurs to a comparable degree in patients with minor and moderate stroke. Furthermore, a reduction in mature dendritic cells occurs and this confirms a recent study which shows that Langerhans cells provide a neuro-protective function. Larger longitudinal studies are required to assess the utility of CCM in assessing DC density and to interrogate their role in ischemic stroke.