{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T02:21:24Z","timestamp":1789870884791,"version":"4.0.1"},"reference-count":73,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University International Postgraduate Award (UIPA) from UNSW"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: To assess diurnal changes, topographical differences, and day-to-day repeatability of ocular surface epithelial immune cell (EIC) density and morphology in dry eye disease (DED). Methods: Sixteen participants with moderate-to-severe DED (mean (SE) age 49.4 (4.2) years) underwent in vivo confocal microscopy at three timepoints (day-1 morning and evening and day-2 morning) at six locations: central cornea, inferior whorl, inferior cornea, and temporal cornea, limbus and conjunctiva. Diurnal and topographical variation in EIC density and morphology were analyzed using linear mixed-effects models with adjusted pairwise comparisons. Day-to-day repeatability was assessed using the coefficient of repeatability (CoR) for density and Cohen\u2019s kappa for morphology. Results: EIC density and morphology varied by location (p &lt; 0.001) but not by timepoint at any location (p = 0.59\u20130.90). Density was highest at the inferior cornea (model-estimated mean: 101.2 (SE: 21.7) cells\/mm2) and temporal limbus (104.3 (22.7) cells\/mm2), and lowest at the central cornea (26.8 [5.1] cells\/mm2 and inferior whorl (38.3 [8.2] cells\/mm2; all pairwise, p &lt; 0.001). EICs with large bodies were more frequent in conjunctiva (100%), inferior cornea (94%), and temporal cornea (87%), than in central cornea (34%) and whorl (19%) (all p \u2264 0.007). EICs with dendrites, and with long dendrites were similarly distributed (p &lt; 0.001). Bland\u2013Altman analysis showed low mean bias and EIC density was more repeatable at the central (CoR \u00b1 23.8 cells\/mm2) and temporal cornea (\u00b127.5 cells\/mm2) than the inferior cornea (\u00b147.9 cells\/mm2) or temporal conjunctiva (\u00b142.3 cells\/mm2). Morphology agreement was substantial to near-perfect (\u03ba = 0.71\u20130.97). Conclusions: In DED, EIC density and morphology are diurnally stable and maintain topographic distribution patterns similar to healthy eyes. Day-to-day repeatability show location dependent patterns. The study provides feasibility data for using IVCM for EIC metrics in disease monitoring.<\/jats:p>","DOI":"10.3390\/jcm15072582","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T15:45:42Z","timestamp":1774626342000},"page":"2582","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diurnal Variation, Topographical Distribution and Day-to-Day Repeatability of Ocular Surface Epithelial Immune Cells in Individuals with Dry Eye Disease"],"prefix":"10.3390","volume":"15","author":[{"given":"Soumen","family":"Sadhu","sequence":"first","affiliation":[{"name":"Optometry Clinic, School of Optometry and Vision Science, University of New South WalesSydney, Level 3, North Wing, RMB, Gate 14, Barker Street, Sydney, NSW 2052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1351-0072","authenticated-orcid":false,"given":"Isabelle","family":"Jalbert","sequence":"additional","affiliation":[{"name":"Optometry Clinic, School of Optometry and Vision Science, University of New South WalesSydney, Level 3, North Wing, RMB, Gate 14, Barker Street, Sydney, NSW 2052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blanka","family":"Golebiowski","sequence":"additional","affiliation":[{"name":"Optometry Clinic, School of Optometry and Vision Science, University of New South WalesSydney, Level 3, North Wing, RMB, Gate 14, Barker Street, Sydney, NSW 2052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7203-5443","authenticated-orcid":false,"given":"Fiona","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Optometry Clinic, School of Optometry and Vision Science, University of New South WalesSydney, Level 3, North Wing, RMB, Gate 14, Barker Street, Sydney, NSW 2052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.jtos.2017.05.011","article-title":"TFOS DEWS II pathophysiology report","volume":"15","author":"Bron","year":"2017","journal-title":"Ocul. 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