Autonomic dysregulation in Parkinson’s disease (PD) can precede motor deficits and is associated with reduced quality of life, disease progression, and increased mortality. Objective markers of autonomic involvement in PD are limited. Corneal confocal microscopy (CCM) is a rapid ophthalmic technique that can quantify small nerve damage in a range of peripheral and autonomic neuropathies. Here we investigated whether CCM can be used to assess autonomic symptoms in PD. Based on the scale for outcomes in Parkinson’s disease for autonomic symptoms (SCOPA-AUT), patients with PD were classified into those without autonomic symptoms (AutD-N), with single (AutD-S), and multiple (AutD-M) domain autonomic dysfunction. Corneal nerve fiber pathology was quantified using CCM, and the relationship with autonomic symptoms was explored. The study enrolled 71 PD patients and 30 control subjects. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and CNBD/CNFD ratio were lower in PD patients with autonomic symptoms compared to those without autonomic symptoms. Autonomic symptoms correlated positively with CNFD (r = −0.350, p = 0.004), and were not related to Levodopa equivalent daily dose (r = 0.042, p = 0.733) after adjusting for age, disease severity, disease duration or cognitive function. CCM parameters had high sensitivity and specificity in distinguishing patients with PD with and without autonomic symptoms. PD patients with autonomic symptoms have corneal nerve loss, and CCM could serve as an objective ophthalmic imaging technique to identify patients with PD and autonomic symptoms.

帕金森病 (PD) 的自主神经失调可能先于运动障碍，并与生活质量下降、疾病进展和死亡率增加有关。PD自主神经受累的客观标志物是有限的。角膜共聚焦显微镜 (CCM) 是一种快速的眼科技术，可以量化一系列外周和自主神经病变中的小神经损伤。在这里，我们调查了 CCM 是否可用于评估 PD 的自主神经症状。根据自主神经症状帕金森病结局量表 (SCOPA-AUT)，将 PD 患者分为无自主神经症状 (AutD-N)、单域 (AutD-S) 和多域 (AutD-M)自主神经功能障碍。使用 CCM 量化角膜神经纤维病理学，并探讨与自主神经症状的关系。该研究招募了 71 名 PD 患者和 30 名对照受试者。与没有自主神经症状的患者相比，有自主神经症状的 PD 患者的角膜神经纤维密度 (CNFD)、角膜神经分支密度 (CNBD)、角膜神经纤维长度 (CNFL) 和 CNBD/CNFD 比值较低。自主神经症状与 CNFD 呈正相关（r  = -0.350, p = 0.004)， 在调整年龄、疾病严重程度、疾病持续时间或认知功能后， 与左旋多巴当量日剂量 ( r  = 0.042, p = 0.733) 无关。CCM 参数在区分伴有和不伴有自主神经症状的 PD 患者方面具有较高的敏感性和特异性。有自主神经症状的 PD 患者存在角膜神经丢失，CCM 可以作为客观的眼科成像技术来识别患有 PD 和自主神经症状的患者。