Korean J Ophthalmol.  2014 Apr;28(2):122-129. 10.3341/kjo.2014.28.2.122.

The Correlation of Routine Tear Function Tests and Conjunctival Impression Cytology in Dry Eye Syndrome

• Kumar P
• Bhargava R
• Kumar M
• Ranjan S
• Kumar M
• Verma P

• KMID: 1792105
• DOI: http://doi.org/10.3341/kjo.2014.28.2.122

Abstract

PURPOSE
To establish the strength of the association between routine tear function tests and conjunctival impression cytology (CIC) and to determine whether they simulate the morphological and cytological changes that occur on the ocular surface in dry eye. What are the sensitivity, specificity and positive predictive values of these tests when CIC is considered the gold standard?
METHODS
The tear film profile included tear film break up time (TBUT), Schirmer's-1, Rose Bengal scores (RBS), and impression cytology. CIC samples were obtained from the inferior bulbar conjunctiva and stained with periodic acid-Schiff and counter stained with hematoxylin and eosin.
RESULTS
The mean Schirmer's value was 11.66 +/- 5.90 in patients and 17.17 +/- 2.97 in controls (p < 0.001). The mean TBUT in participants was 8.88 +/- 3.54 and 13.53 +/- 2.12 in controls (p < 0.001). Patients had a mean goblet cell density (GCD) of 490 +/- 213, while the value for controls was 1,462 +/- 661 (p < 0.001). Abnormal CIC was observed in 46.7% cases of dry eye and in 32.8% of controls. The correlation coefficient (L) for Schirmer's was 0.2 and 0.24 for participants and controls, respectively, while TBUT values were 0.26 and 0.38, RBS were 0.5 and 0.5, and GCD was 0.8 and 0.6 in cases and controls, respectively.
CONCLUSIONS
GCD, RBS, and TBUT were better predictors of morphological and cytological changes in the conjunctiva than Schirmer's in dry eye syndrome. The sensitivity of tear function tests in diagnosing dry eye was TBUT > Schirmer's > RBS, and the specificity was Schirmer's > TBUT > RBS in decreasing order when CIC was considered the gold standard.

Keyword

Conjunctiva; Goblet cells; Tears

MeSH Terms

Adolescent
Adult
Case-Control Studies
Child
Conjunctiva/pathology
Diagnostic Techniques, Ophthalmological/*standards
Dry Eye Syndromes/*diagnosis/*pathology
Eosine Yellowish-(YS)/diagnostic use
Female
Goblet Cells/pathology
Hematoxylin/diagnostic use
Humans
Male
Middle Aged
Ophthalmology/*standards
Periodic Acid-Schiff Reaction/standards
Predictive Value of Tests
Rose Bengal/diagnostic use
Sensitivity and Specificity
*Tears
Young Adult
Eosine Yellowish-(YS)
Hematoxylin
Rose Bengal

Figure

• 

  Fig. 1 (A) Scatter diagram showing correlation between Schirmer's test and conjunctival impression cytology. (B) Scatter diagram showing correlation between tear film break up time and conjunctival impression cytology. (C) Scatter diagram showing correlation between Rose Bengal score and conjunctival impression cytology. (D) Scatter diagram showing correlation between goblet cell density and conjunctival impression cytology. (E) Periodic acid-Schiff stained impression cytology specimen with mild dry eye and a reduced goblet cell count. (F) Periodic acid-Schiff stained image with squamous metaplasia, inflammatory infiltration and a decrease in goblet cells.

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