Gordana Stanković-Babić, Jasmina Gligorijević, Sonja Cekić, Gordana Zlatanović, Jovan Stojanović

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Dry eye is among the most common pathological conditions in ophthalmology. The aim of our study was to present possibilites of two different cytological methods for examination of cytomorphology of bulbar conjunctival cells- impression cytology (IC) and combined cytological method for scanning electron microscopy in the diagnosis  of dry eye (ICSEM). A hundred and twenty-two patients of both sexes, in different age groups, were analyzed by clinical method (slit lamp, Schirmer I, TBUT, Rose Bengal) and two cytomorphological methods – IC and ICSEM. In patients with dry eye, squamous metaplasia, inflammation and severe loss of adhesiveness of the epithelium were present. ICSEM gives an advantage in early diagnosis of changes, before the lesion of superficial conjunctival epithelium in patients with dry eye. The phenomenon of metaplasia appears in the epithelium of the bulbar conjunctiva in the absence of manifest dry eye and represents the basis for understanding the increased incidence of this syndrome in older patients with dry eye.


dry eye, impression cytology, cytological method for scanning electron microscopy

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Brewit H, Sistani F. Dry eye disease: the scale of the problem. Surv Ophthalmol 2001; 45:199-202.

Perry H.D. Dry eye disease: pathophysiology, classification, and diagnosis. Am J Manag Care 2008; 14:79-87.

Stern ME, Schaumburg CS, Pflugfelder SC. Dry eye as a mucosal autoimmune disease. Int Rev Immunol 2013; 32(1):

-41. doi: 10.3109/08830185.2012.748052

Schaumberg DA, Sulliuvan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol 2003; 136:318-326.

Vitale S, Goodman LA, Reed GF, Smith JA. Comparison of the NEI–VFQ and OSDI questionnaires in patients with Sjögren's syndrome-related dry eye. Health Qual Life Outcomes 2004; 2: 44.

Chia EM, Franzco PM, Rochtchina E, Lee AJ, Maroun R, Wang JJ. Prevalence and associatiations of dry eye syndrome in an older population: the Blue Mountains Eye Stydy. Clin Exp Ophthalmol 2003; 31:229-232

Patel S, Blades JK. The dry eye. A Practical Approach. Butterworth-Heinemann, 2003; 14-65.

Egbert PR, Lauber S, Maurice DM. A simple conjunctival biopsy. Am J Ophthalmol 1977; 84:798-801

Mc Kelvie, P. Ocular surface impression cytology. Adv Anat Pathol 2003; 10:328-337.

Singh R, Joseph A, Umapathy T, Tint NL, Dua SH. Impression cytology of the ocular surface. Br J Ophthalmol 2005; 89:1655-1659.

Cennamo GL, Del Prete A, Fort R, Cafiero G, Del Prete S, Marasco D. Impression cytology with scanning electron microscopy: a new method in the study of conjunctival microvilli. Eye 2008; 22(1):138-143.

Haller-Schober E-M, Schwantzer G, Berghold A, Fisch M, Theisl A, Horwath-Winte J. Evaluating an impression cytology grading system (IC score) in patients with dry eye syndrome. Eye 2006; 20:927-933.

Versura P, ProfazioV, Cellini M, Torreggiani A, Caramazza R. Eye discomfort and air pollution. Ophthalmologica 1999; 213(2):103-109.

Abelson MB, Ousler GW. Ocular Protection Index. Dry Eye Expert Summit. Rev of Ophthalmol 2003; 2:15.

Marner K. Snake-like appearance of nuclear chromatin in conjunctival epithelial cells from patients with keratoconjunctivitis sicca. Acta Ophthalmol (Copenh) 1980; 58:849–853.

Calonge M, Diebold Y, Sáez V, Enríquez de Salamanca A, Garsía-Vázquez C, Corrales RM, et al. Impression cytology of the ocular surface - a review. Exp Eye Res 2004; 78:457-472.

Torok M, Suveges I. Morphological changes in »dry eye syndrome«. Grafe´s Arch Clin Exper Ophtalmol 1982; 219: 24-28.

Kinoshita S, Kiorpes TC, Friend J, Thoft RA. Goblet cell density in ocular surface disease. Arch Ophthalmol 1983; 101: 1284-1287.

Murube J, Rivas L. Biopsy of the conjuctiva in dry eye patients establishes a correlation between squamous metaplasia and dry eye. Eur J Ophtalmol 2003; 13:246-256.

Wittpenn JR, Tseng SC, Sommer A. Detection of early xerophthalmia by impression cytology. Arch Ophthalmol 1996; 104:237–239.

Sternlicht MD, Werb Z. How matrix metalloproteinases regulate cell behavior. Annu Rev Cell Dev Biol 2001; 17: 463516.

Thoft RA, Friend J, Kinoshita S, Nikolic L, Foster S. Ocular cicatricial pemphigoid associated with hyperproliferation of the conjunctival epithelium. Am J Ophthalmol 1984; 98:37-42.

Kinoshita S, Adachi W, Sotozono C, Nishida K, Yokoi N, Quantok AJ,et al. Characteristics of the human ocular surface epithelium. Prog Ret Eye Res 2001; 20(5):634-639.

Moss SE, Klein R, Klein BEK. Incidence of Dry Eye in an Older Population. Arch Ophthalmol 2004; 122:369-373.

Moss SE, Klein R, Klein BEK. Prevalence of and Risk Factors for Dry Eye Syndrome. Arch Ophthalmol 2000; 118:


Vujković V, Mikač G, Kozomara R. Distribucija i gustina peharastih ćelija u konjunktivi. Med Preg 2002; 5-6:195-200.

Jie Y, Xu L, Wu YY, Jonas JB. Prevalence of dry eye among adult Chinese in the Beijing eye study. Eye 2008;23: 688-693.

Mc Carty CA, Bansal AK, Livingston PM, Stanislavsky YL, Taylor HR. The epidemiology of dry eye in Melbourne, Australia. Ophthalmol 1998; 105:1114-1119.

Sangwan VS, Tseng CG. New perspectives in ocular surface disorders. An integrated approach for diagnosis and management. Ind J Ophtalmol 2001; 49:152-168.

Wei L, Hayashida Y, Ying-Ting C, Hua H, David YT, Morgan A Air Exposure–Induced Squamous Metaplasia of Human Limbal Epithelium. Invest Ophthalmol Vis Sci 2008; 49(1): 154–162.



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