The Association of Conjunctival Snake-Like Chromatin with Keratoconjunctivitis Sicca

Purpose

This work describes the snake-like chromatin cells in the conjunctiva of patients with keratoconjunctivitis sicca (KCS), assessing the relationship between tear function parameters and the severity of the disease, and searching for any differential pattern that could lead to early and diagnosis help clarify the etiology of KCS.

Methods

The conjunctiva of 366 eyes from 187 patients with KCS, and 30 eyes from 15 controls, were classified according to the results of the Schirmer I test, break-up time, rose Bengal staining, osmolarity, ferning tests and electrophoresis; they were then studied by impression cytology and electron microscopy.

Results

Snake-like chromatin cells, other nuclear changes, and a decreased number of goblet cells were found by impression cytology in different areas of the KCS conjunctiva. The presence of snake-like chromatin was significantly correlated with the severity of the disease. No nuclear changes were found in the control group.

Conclusions

We assume these findings can be attributed to a natural regeneration of conjunctival cells and to resistance to a pathological reaction to KCS.

Ultrastructural Study of the Conjunctiva in Patients with Keratoconjunctivitis Sicca not Associated with Systemic Disorders

Purpose

The aim of this work was to evaluate ultrastructural alterations of the conjunctiva during the clinical course of keratoconjunctivitis sicca (KCS), and to detect its earliest and most characteristic morphological changes.

Methods

The conjunctiva was studied in biopsies from 75 patients and 10 controls. Patients were classified according to the results of the Schirmer I test, break-up time, rose Bengal staining, osmolarity and impression cytology.

Results

The conjunctiva in these KCS patients showed progressive hyperplasia, hypertrophy and cellular flattening, with diminution of goblet cell density and microvilli. In the severe cases, the epithelial cells lost their organelles, and fibrous material increased. From the early phases of KCS, clear nuclear alterations (indentation, binucleation) were found, but pyknotic nuclei or anucleated cells were only observed in the most severe cases. From the earliest stages to the most severe cases of KCS, decreases in cell membrane interdigitations were observed parallel to increases in the number and size of desmosomes. There were also increases in the number of inflammatory cells. Alterations in blood vessels were only observed in the most severe cases.

Conclusions

Morphological studies alone were able even in the earliest phases of KCS, to detect the squamous metaplasia that progresses from the surface of the epithelium to the connective tissue. This degenerative or adaptative cellular process was characterized mainly by marked proliferation of the cytoskeleton and a general loss of organelles, mitochondria being the least affected.

[Impression cytology contribution to differential diagnosis of Sjögren syndrome in the ophthalmological clinic]

PURPOSE

First, to assess the use of impression cytology, clinical and laboratory tests in the daily clinic for the early diagnosis of Primary Sjögren Syndrome (SS1), and second, to establish morphological differences between SS1, keratoconjunctivitis sicca (KCS) and healthy controls using impression cytology.

MATERIAL AND METHOD

The study comprised 35 patients suffering from primary Sjögren syndrome, same number of patients with keratoconjunctivitis sicca and normal healthy subjects. All groups underwent clinical tests (Schirmer's test, break-up time, and bengal rose staining), laboratory tests (tear protein pattern, tear osmolarity and serum immunoglobulin readings), and impression cytology on different areas of the conjunctiva and cornea.

RESULTS

All patients presented one or more subjective symptoms of ocular irritation although seeming normal at naked eye. Two patients with Sjögren's syndrome showed total corneal keratinization. Clinical and laboratory tests did not show significant differences between Sjögren's syndrome patients group and keratoconjunctivitis group. Serum tests of antibodies and immunoglobulins did present diagnostic values. Impression cytology showed significant differences between Sjögren syndrome patients compared to the rest of groups with regard to epithelial and goblet cells.

CONCLUSIONS

Impression cytology consists in a hystopathological test and it is considered the only ophtalmological test that offers a differential diagnosis in Sjögren's syndrome and should be included in a classification criteria. Inpression cytology presents significant differences between Sjögren syndrome and keratoconjunctivitis sicca.

[Comparison of 2 lacrimal punctal occlusion methods]

PURPOSE

To study and compare two methods for canalicular occlusion: Cautery and Punctal Patch.

METHOD

The study included fourty patients divided in two groups of 20 patients. The end point was 4 occluded puncti. The first group underwent deep cauterization resulting in occlusion of the full vertical aspect of the canaliculus. The second group underwent punctal patch technique for canalicular occlusion. Differential parameters were the following: time of intervention, ease of use, risks and precision. In the post operatory, discomfort, subjective and objective improvement in ocular surface as well as long term result of each technique was analysed.

RESULTS

Time of intervention was longer for punctal patch compared to cautery. Both methods exhibited similar ease of use and improvement in ocular surface. Precision was high in punctal patch technique showing complete and final occlusion and no punctum needed reopening, while cautery technique presented 20% rate of reopening intervention. Postoperatory discomfort and irritation were remarkably evident with punctal technique, while minimal in cautery technique.

CONCLUSION

Survival analysis after one year follow up, showed a higher rate of advantages for punctal patch technique over cautery technique.

[Histopathological and immunohistochemical study of the ocular cicatricial pemphigoid]

OBJECTIVE

To study the relationship between the histopathological alterations and the clinical severity grade in the first phases of the ocular cicatricial pemphigoid to facilitate early diagnosis of the disease and initiate treatment as early as possible.

MATERIAL AND METHODS

We have studied 10 patients with different clinical grades of severity (3 patients with grade I; 4 patients with grade II; 2 patients with grade III, and 1 patient with grade IV). For these patients, full ophthalmologic examinations were performed [clinical, laboratory tests, impression cytology, ultrastructural study, study of direct (IFd) and indirect immunofluorescence (IFi).

RESULTS

The different techniques used have enabled us to observe the diminution of goblet cells, the initiation of subepithelial bullae, separation of epithelial basement membrane, increase and disorganization of collagen fibers, increase in the number of desmosomes, decrease in the number of hemidesmosones, increase in the intraepithelial fibrillar materials and the presence of immunoglobulin deposits and complement in the basement membrane of these patients in the early phases of the disease.

CONCLUSION

The techniques used in this study have enabled us to make an earlier diagnosis of the disease, since it manifests the eye dryness immediately and the posterior biopsy can confirm the differential diagnosis.

Correlation between impression cytology and tear function parameters in Sjögren's syndrome

We have compared clinical (Schirmer I test, BUT and rose bengal staining), laboratory (lysozyme and lactoferrin tear levels) and histological tests (impression cytology) in 165 eyes from 85 patients with primary Sjögren's syndrome and in 80 eyes from 40 control subjects. Impression cytology can provide the location of cellular alterations on the ocular surface and information on the severity of the disease. The upper bulbar and interpalpebral areas from patients with primary Sjögren's syndrome were shown to have cellular alterations early in the course of the disease, while the lower bulbar and lower palpebral areas were only affected in severe cases. Statistical analysis has shown that impression cytology and rose bengal staining are the most specific and sensitive methods for the diagnosis of primary Sjögren's syndrome.

Morphological changes in ocular surface in dry eyes and other disorders by impression cytology

A study was conducted on 107 eyes of 70 patients with dry eye disorders and mechanical and chemical extrinsic alterations and 64 eyes of 32 control subjects in order to describe a possible specific response of the conjunctival and corneal surface. We found the presence of "snakelike" chromatin cells and other nuclear changes, squamous metaplasia, and inflammatory cells in the conjunctiva in all groups. A decrease in goblet cell densities was also found in all groups, except for patients with blepharoconjunctivitis. The corneal cells were slightly larger in patients with keratoconjunctivitis sicca.

Topographical distribution of ocular surface cells by the use of impression cytology

Cytology impression samples of the conjunctiva and the cornea were obtained from normal eyes. Our results were in agreement with most authors, except in the interpalpebral areas. In the interpalpebral areas, we found new data about superficial cell distribution not described before; the non-secretory cells were more separated and larger, with a higher nuclear-cytoplasmic ratio than other areas. The secretory cells (goblet cells) had significantly decreased with respect to the rest. In the interpalpebral areas, near the limbal areas, no goblet cells were found, and the size of non-secretory cells was increased, the density was lower and the nuclear-cytoplasmic ratio was higher, with regards to the external areas. The corneal epithelial cells had a similar morphological appearance in all specimens tested. We confirm that our subjects were absolutely normal, and conclude that environmental factors might explain why the cells were slightly transformed.