Clinical Usefulness of Conjunctival Brush Cytology in the Diagnosis of Dry Eye Syndrome

Hyung-Jin Moon; Chang-Su Park; Kyung-Chul Yoon

doi:10.3341/jkos.2009.50.3.340

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Moon, Park, and Yoon: Clinical Usefulness of Conjunctival Brush Cytology in the Diagnosis of Dry Eye Syndrome

Original Article

J Korean Ophthalmol Soc 2009;50(3):340-346.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.3.340

Clinical Usefulness of Conjunctival Brush Cytology in the Diagnosis of Dry Eye Syndrome

Hyung-Jin Moon, MD¹, Chang-Su Park, MD², Kyung-Chul Yoon, MD¹

¹Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Korea

²Department of Pathology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD, Department of Ophthalmology, Chonnam National University Medical School & Hospital, #8 Hak-dong, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@jnu.ac.kr

Received 10 June 2008 Accepted 4 November 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical usefulness of conjunctival brush cytology (CBC) in the diagnosis of dry eye syndrome.

Methods

Conjunctival impression cytology (CIC) was performed on the right eye and CBC was performed on the left eye in 24 patients with dry eye syndrome (9 patients with Sjӧ gren's syndrome (SS) and 15 patients with non-Sjӧ gren syndrome (Non-SS)) and 7 control subjects. The grade of squamous metaplasia was analyzed and the correlation between the grade and tear surface parameters was evaluated.

Results

The squamous metaplasia grade score in CIC and CBC were 2.44±0.73 and 1.56±1.01 in SS patients (p=0.047), 1.53±0.74 and 0.80±0.78 in Non-SS patients (p=0.017), and 0.43±0.54 and 0.14±0.38 (p=0.250) in control subjects, re-spectively. In SS patients, the score correlated significantly with the symptom score, basal tear secretion, break-up time (BUT) and keratoepitheliopathy score in CBC (p＜0.05), but did not correlate with the tear surface parameters in CIC. In Non-SS patients, the score correlated significantly with the symptom score, basal tear secretion, BUT and keratoepitheliopathy score in CBC, and with the keratoepitheliopathy score in CIC (p＜0.05).

Conclusions

CBC is a more useful method than CIC in the diagnosis of dry eye syndrome.

Keywords: Conjunctival brush cytology, Conjunctival impression cytology, Dry eye syndrome, Tear surface parameter

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Figure 1.

Comparison of the grade of conjuctival squamous metaplasia between conjunctival brush and impression cytology. ^* p value<0.05; ^† Non-SS: Non-Sjӧgren's syndrome; ^‡ SS: Sjӧgren's syndrome.

Figure 2.

Goblet cell density of controls, Non-SS, SS patients in conjunctival brush and impression cytology.^* p<0.05 compared with control; ^† p<0.05 compared with Non-SS; ^‡ Non-SS=Non-Sjӧgren's syndrome; ^§ SS= Sjӧgren's syndrome.

Figure 3.

Correlation between squamous metaplasia grades by conjuctival brush and impression cytology and tear surface parameters, including symptom score (A), basal tear secretion (B), tear clearance rate (C), tear break up time (D), and keratoepitheliopathy score (E) in Sjӧgren syndrome patients.

Figure 4.

Correlation between squamous metaplasia gradesconjuctival brush and impression cytology and tear surface parameters including symptom score (A), basal tear secretion (B), tear clearance rate (C), tear break up time (D), and keratoepitheliopathy score (E) in Non-Sjӧgren syndrome patients.

Table 1.

Dermographic data in subjects for conjunctival impression cytology and brush cytology

	SS^§	Non-SS^∥	Control
Patients number	9	15	7
Male/Female	0/9	6/9	3/4
Age (years)	50.4±14.6	41.8±13.9	41.4±16.4
Symptom score	2.67±0.87^*	2.00±0.93^†	0.14±0.38
Basal secretion test (mm)	4.44±1.59^*	5.33±1.95^†	10.57±1.62
Tear clearance rate ((Log₂)^-1)	2.39±0.61^*‡	3.57±0.90	4.00±0.39
Break up time (sec)	4.89±1.27^*‡	5.67±1.40^†	10.71±1.25
Keratoepitheliopathy score	3.89±1.45^*‡	1.07±0.80^†	0.14±0.38

^*p<0.05 compared with controls

^†p<0.05 compared with controls

^‡p<0.05 compared with Non-SS

^§SS=Sjӧgren's syndrome

^∥NSS=Non-Sjӧgren's syndrome.

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