In-vivo Confocal Microscopy

In-vivo confocal microscopy is a novel diagnostic tool that allows ophthalmologists to visualize the cornea and other structures within the eye in high resolution. High resolution, in-vivo imaging of all five layers of the cornea removes the need for invasive, time-consuming, expensive and painful biopsies for patients. The five layers are the corneal epithelium, Bowman’s layer, stroma, Descemet’s membrane and the corneal endothelium.

Due to it being non-invasive (and by extension, not painful!), it has huge clinical potential to readily investigate numerous corneal diseases. It is already used in the detection and management of pathologic and infectious conditions, corneal dystrophies and ecstasies, monitoring contact lens induced corneal changes and for pre and post-surgical evaluation (PRK, LASIK and LASEK etc.), and penetrating keratoplasty. More recently, the nerves on the cornea have been studies to assess progression of certain diseases that damage corneal nerves – an example is diabetes.

At the time of the conception of Eyes2Eyes in 2021, and still to our knowledge today, there was no in-vivo Confocal Microscope in the Western Cape; in fact, there is only one of these microscopes in the whole of South Africa, which is privately owned in Gauteng. The ability to procure an in-vivo Confocal Microscope in public and private sector medical facilities is currently hindered by extensive costs (exceeding 1 million ZAR) from international manufacturers.

One of the core aims of Eyes2Eyes is to procure an in-vivo confocal microscope to improve the screening and diagnostic capacity Western Cape ophthalmology services.

Listed briefly below are five benefits of this technology for both ophthalmologists and patients:

  1. Real-time imaging: Confocal microscopy provides real-time images of the cornea, allowing ophthalmologists to dynamically monitor changes in the cornea during an exam.
  2. Early detection: By detecting corneal diseases and conditions in their early stages, in-vivo confocal microscopy can lead to earlier treatment and better outcomes for patients.
  3. Non-invasive, improved diagnosis: Confocal microscopy provides high-resolution images of the cornea, allowing ophthalmologists to diagnose a range of corneal diseases and conditions with greater accuracy. In-vivo confocal microscopy is a non-invasive technique, allowing ophthalmologists to examine the cornea without the need for surgical procedures.
  4. Reduced risk of complications: By avoiding invasive procedures, in-vivo confocal microscopy reduces the risk of complications for patients.
  5. Better patient outcomes: With more accurate diagnosis and improved monitoring, patients are likely to receive more effective treatments, leading to better outcomes.


  1. Tavakoli M, Hossain P, Malik RA. Clinical applications of corneal confocal microscopy. Clin Ophthalmol. 2008;2(2):435-445.
  2. Petropoulos IN, Bitirgen G, Ferdousi M, et al. Corneal Confocal Microscopy to Image Small Nerve Fiber Degeneration: Ophthalmology Meets Neurology. Frontiers in Pain Research 2021;2.


Image reproduced under CC BY4.0 open access using article reference (2).

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