Role of Impression Cytology in Detecting Gobletcell Damage in Various Ocular Surface Disorder

Special Article - Ophthalmology: Clinical Cases and Images

Austin J Clin Ophthalmol. 2016; 3(1): 1065.

Role of Impression Cytology in Detecting Gobletcell Damage in Various Ocular Surface Disorder

Thatte Shreya* and Garg Poorvi

Department of Ophthalmology, Shri Aurbindo Institute of Medical Sciences, India

*Corresponding author: Thatte Shreya, Department of Ophthalmology, Shri Aurbindo Institute of Medical Sciences, 17, Yeshwant Colony Behind Sita Building , Indore (MP), India

Received: March 16, 2016; Accepted: May 25, 2016; Published: May 30, 2016


Purpose: Normal ocular surface is maintained by healthy goblet cells.Any insult to normal ocular surface can lead to changes in goblet cells. The amount of changes in goblet cells depend on severity of OSD. The aim of this study is to demonstrate the correlation between goblet cells alteration and OSD using impression cytology.

Material and Method: Thirty nine cases with veneralkeratoconjuctivities (8), stevenjohnson syndrome (6), squamous cell carcinoma (4), pingecula (3), conjunctival melonosis(1), primary pterygium (10) and recurrent pterygium (7) were included in this study and underwent impression cytology.

Result: Changes in goblet cells morphology,studied by impression cytology were classified according to Saine et all criteria. Grade1 impression cytology changes were seen in conjunctival melanosis.Mild to moderateVKC, SJS, pingecula and recurrent pterygium showed grade 2 impression cytology changes.Incidence of grade 3 impression cytology was observed in squamous cell carcinomaand severe VKC. Grade 2 and 3 impression cytology changes were seen in primary, fleshy pterygium in equal percentage.

Conclusion: Impression cytology is a simple non invasive technique which offers to evaluate damage to goblet cell morphology which is helpful in detecting severity of OSD.

Keywords: Ocular surface; Impression cytology; Goblet cell morphology


OSD: Ocular Surface Disorders; VKC: Veneral Kerato Conjuctivities; SJS: Steven Johnson Syndrome; PAS: Periodic Acid Schiff


Ocular surface consist of bulbar conjunctiva, palpebral conjunctiva, forniceal conjunctiva, limbus, corneal epithelium and pre corneal tear film [1].

Tear film maintains clarity of the cornea by regulating the moisturizationof the conjunctiva and the cornea.Ocular surface protects the globe from mechanical, toxic and infectious trauma¹.

Classification of ocular surface disorders [2].

1. OSD due to conjunctival etiology – goblet cell deficiency, formation of pseudomembranes, formation of follicles.

2. OSD due to tear film- due to lipid deficiency,lid related disorders , evaporative dry eye and aqueous tear deficiency.

3. OSD due to limbal stem cell deficiency.

Conjunctiva has a major contribution in ocular surface and goblet cell are indispensible part of ocular surface. Therefore alteration in ocular surface affects goblet cells morphology .

Goblet cells

These are non keratinized cells located within the epithelium of bulbar conjunctiva which are more dense in lower nasal area and least in upper temporal fornix [3,4]. Main function of these cells is to secrete mucous, innermost layer of tear film which protects ocular surface from dryness. Mucous covering is essential to keep cornea and conjunctiva moist inorder tomaintaining a healthy OS.

Goblet cell population increases in chronic inflammation and diminishes in OS disorders like dry eye syndrome, pterygium, neurotrophic keratitis, atopy, seasonal ocular allergy. Population and morphology of goblet cells can be studied by impression cytology (IC).

Impression cytology

Impression cytology was first described by Egbert et al in 1977 [5]. Usually diagnosis of OSD is made by clinical assessment, but changes in goblet cells are confirmed by impression cytology, which is a standard evaluation to assess goblet cell morphology.It refers to the application of a cellulose acetate filter to the ocular surface to remove the superficial layers of the ocular surface epithelium which are subjected to histological, immunohistological or molecular analysis [6]. Most commonly used stains are Periodic Acid Schiff and Papanicolaou stain.Generally 2 to 3 layers of cells are removed in one application but deeper cells can be accessed by repeat application over same site. Impression cytology is a minimally invasive method with little patient discomfort and relatively easy method to study conjunctival goblet cells morphology and density. The use of impression cytology is indicated in order to identify etiological diagnosis of preclinical lesions and to typify the OSD. Application include etiological diagnosis of variouspre clinical and established ocular surface disorders,ocumenting sequential changes in the conjunctival and corneal surface over time, pre and post treatment of dry eye, staging of squamous metaplasia and monitoring effects of treatment [6].

Materials and Method

It is prospective monoinstitusional study done within a span of one year . Patients attending out patient department with clinically diagnosed as cases of OSD were examined and those gave consent for the investigative procedure of impression cytology were enrolled . Thus we could include thirty nine eyes of various types of ocular surface disorder in the study,

Patients with VKC (8), SJS (6), squamous cell carcinoma (4), pingecula (3), conjunctival melonosis (1), primary pterygium (10) and recurrent pterygium (7) underwent impression cytology, were included in the study (Figure 1).