<em>In Vivo</em> Confocal Microscopy in the Diagnosis and Management of Dry Eye: A Focus on Imaging Protocols and Interpretation

In vivo confocal microscopy (IVCM) has gained significant attention for its non-invasive nature and high resolution. It enables in vivo observation and objective quantification of numerous dry eye disease (DED)-related ocular surface structures, including the cornea, conjunctiva, eyelid margin, meibomian glands, and parasites such as Demodex, at the cellular level. This capability assists ophthalmologists in identifying specific etiologies and subtypes of DED, thereby facilitating precise diagnosis, targeted treatment, and prognostic evaluation. However, standardized protocols for IVCM operation and reporting remain lacking. Proficiency in both ophthalmic knowledge and technical operation is essential to effectively utilize this device and generate high-quality reports. This article details the procedural steps and nuances of IVCM examination for DED patients. This is the first JoVE step-by-step IVCM protocol for DED. It aims to serve as a reference for clinicians, helping them avoid operational inefficiencies and consistently obtain high-quality corneal and ocular surface images to guide clinical management.