Conjunctival Surface Damage Distribution in Keratoconjunctivitis sicca An Impression Cytology Study

Abstract

Impression cytology was used to study the ocular surface of 32 eyes with keratoconjunctivitis sicca. Among these eyes, on the basis of the results of the Schirmer I test, two groups of eyes have been identified. The first group with Schirmer test < 5.5 mm/5 min showed decreased concentration of goblet cells and increased cytoplasm/nucleus ratio on all the areas of the bulbar conjunctiva. The second group, with Schirmer test > 5.5 mm/5 min, showed similar changes to be localized in the interpalpebral bulbar conjunctiva only, while the eye surface protected by the lids was almost normal. These observations suggest a pathogenetic role of tear evaporation in eyes with tear film instability even in the presence of a ‘theoretically’ normal tear production.

Evaluation of conjunctival morphology in thyroid associated eye disease by use of impression cytology

“…Rolando et al (1990) reported that in patients with dry eyes and normal Schirmer test values, the goblet cell density in the interpalpebral area was lower than the bulbar conjunctival areas under eyelids, related to evaporation. The reason for higher goblet cell density in the upper bulbar conjunctiva is the protective effect of the upper eyelid.…”

“…The modification of stratified non-keratinized secretory epithelium to non-secretory keratinized epithelium is called squamous metaplasia. Squamous metaplasia has been demonstrated in diseases of dry eyes and atopic conjunctivitis, and this has been suggested to be a non-specific indicator of ocular surface disease (Tseng 1985;Adams et al 1988;Kinoshita et al 1983;Rivas et al 1991;Rolando et al 1990). It has been proposed that inflammation and loss of vascularization related to scar tissue were the causes of squamous metaplasia (Tseng 1985).…”

Emerging treatment paradigms of ocular surface disease: proceedings of the Ocular Surface Workshop

“…When impression cytology was performed in dysfunctional tear syndromes, the presence of a Schirmer eye test of >5.5 mm/5′ resulted in damage mostly localised inside the interpalpebral bulbar conjunctiva, while eyes with a Schirmer test of <5.5 mm/5′ showed damage spread in all the quadrants of the bulbar conjunctiva indicating that in eyes with a low tear deficiency, epithelial damaged tended to be limited to the area exposed to evaporative stress 53. Epithelial damage in KCS results in loss of microvilla from the epithelial cell surface after exposure to hyperosmotic environment (fig 3).…”

Evaluating an impression cytology grading system (IC score) in patients with dry eye syndrome

“…Pathological changes, such as squamous metaplasia of the epithelial cells, keratinization, and reduction of goblet cell density up to total goblet cell loss, occur in numerous disorders such as dry eye, Sjö gren's syndrome, blepharokonjunctivitis, inflammatory keratokonjunctivitis, and vitamin A deficiency. [3][4][5][6][7][8][9][10][11][12] For staging of the morphological changes of the conjunctiva, several grading systems have been developed. The first grading system published by Nelson et al 3 was based on the morphological appearance of the conjunctival epithelial and goblet cells, which was completed in 1988 4 by the so-called mean individual epithelial cell area, according to the degree of squamous metaplasia, and the number of goblet cells.…”