Comparison of tear film tests, ocular staining, impression cytology for three conditions: dry eye, anterior blepharitis, seasonal allergic conjunctivitis

AIM: To compare three clinically similar patient groups and a control group in terms of tear function tests, ocular surface staining and conjunctival impression cytology. METHODS: This was a single-centre, prospective, double-blind, randomised and controlled trial. The study includes 20 dry eye patients with Schirmer 1 scores less than 10mm and a tear film break-up time (TBUT) less than 10s, 20 anterior blepharitis patients with drying and crusting of the eyelashes, 20 seasonal allergic conjunctivitis patients with papillary hypertrophy of the upper eyelid tarsal conjunctiva and 20 control group patients. The Schirmer scores, TBUT scores, ocular surface staining (as graded by the Oxford scheme scale), goblet cell density (as observed using impression cytology and metaplasia scores for all patients evaluated by the Nelson grading scheme) were compared. RESULTS: Significant differences were identified between these patient groups and the control group in terms of tear functions tests, ocular surface-staining scores, goblet cell density and metaplasia scores (P<0.001). CONCLUSION: Inflammatory response against these three diseases was demonstrated to cause damage in parallel to the severity of the local inflammation they generate on the ocular surface. We confirmed that this damage has very serious effects, especially on conjunctival goblet cell density and metaplasia. We believe that the degree of this loss in goblet cells is correlated with clinical findings

Effects of topical cyclosporine A plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome

PubMed ID: 21792057Objectives: The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS). Methods: Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group. Results: In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (P<0.001 for all). In the control group, corneal fluorescein staining (P<0.001) and conjunctival lissamine green staining (P=0.014) improved, but BUT and Schirmer scores did not change significantly after treatment. At the end of the 4-month follow-up, the study group demonstrated statistically significantly better BUT (P=0.020), Schirmer scores (P=0.002), goblet cell density (P=0.006), corneal fluorescein staining (P=0.003), and conjunctival lissamine green staining (P=0.017) scores than did the control group. Conclusions: Topical cyclosporine A and artificial tears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health. © 2011 Lippincott Williams & Wilkins