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

Abstract

Purpose To evaluate the IC score, a newly developed grading system for the morphological alterations of the ocular surface as a diagnostic tool in relation to type and severity of dry eye disease. Methods Impression cytological specimens of 309 patients with simple dry eye (S-DE), 50 patients with Sjö gren's syndrome and dry eye (SS-DE), and 39 patients with connective tissue disease and dry eye (CTD-DE) were examined. In all, 10 different morphological parameters were judged with points (IC subscores) and summarized to the IC score. IC score and subscores were correlated to tear function test results and with each other. Results SS-DE patients had the highest IC scores and IC subscores. IC scores and IC subscores correlated significantly with the fluorescein staining of the cornea in all three patient groups. They were correlated to the rose bengal score in SS-DE and S-DE patients. The analysis of the IC subscores showed that there are significant correlations between most of the morphological alterations investigated. This underlines the importance of each parameter for the summarized IC score. Conclusion The IC score provides detailed information about the morphological alterations of the bulbar conjunctiva. It has proven to be useful for the differentiation of dry eye diseases and might help in the investigation of the pathogenesis of these diseases as well as for follow-up and therapy control.

Cytomorphology of the Bulbar Conjunctival Cells in Patients With Dry Eye

“…This adaptive phenomenon reflects the need for protection from external influences, or the response to proliferative stimuli from the environment. These findings agree with the findings from other authors [11,12,15,[16][17][18][19][20][21][22][24][25][26], but aging as a key factor for the appearance of dry eye syndrome was established in numerous studies [2,24,25,27,28].…”

Comparison of Morphology of Bulbar Conjunctival Cells Assessed by Impression Cytology versus Scrape and Smear Methods

“…2 It has become a routine to at least subjectively assess the size of the CIC-obtained epithelial cells and their nucleus staining characteristics, with the cells being graded as normal or abnormal, or as one of the several stages between normal and severe (substantial) squamous metaplasia. [24][25][26][27][28][29] This is in overall contrast to assessments made of cells obtained by scrape or brushing methods, although some investigators have reported making similar grading approaches. 8,10,15,16 Others have assessed the nucelo-cytoplasmic characteristics of scraped cells to categorize them as being from more superficial or deeper lying basal layers of the conjunctival epithelium.…”

“…The conjunctival source material was sheep eyes, obtained in small batches (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) within about 30 min post-mortem, after removal by slaughterhouse staff, and then transported to the lab (for immediate use) in closed plastic bags. Following protocols similar to those used on cow eyes, 30 2-4 eyes from each batch were selected based on having normal external appearance, size (horizontal corneal diameter), and central corneal thickness (ultrasound pachymetry) (see section ''Results'').…”

Reduced in vivo Ocular Surface Toxicity with Polyquad-Preserved Travoprost versus Benzalkonium-Preserved Travoprost or Latanoprost Ophthalmic Solutions

“…Conjunctival impression cytology specimens were photographed using a Leica DM5000 fluorescent microscope with magnification of 200 (Leica, Wetzlar, Germany). A modified Nelson score was used to evaluate the morphology of the conjunctival ocular surface [14,15]. In brief, morphological parameters such as epithelial cell changes, inflammatory infiltration and density of goblet cells were scored from 0 to 3, with 0 = normal/none and 3 = abundant/massive.…”