Abstract: Reduced goblet cell density in dry eye patients

This study, originating in Nepal of all places, is not original and not news, but it's a useful reminder that dry eyes are not just about meibomian and/or lacrimal gland dysfunction. There's the mucin issue as well - which depends on goblet cell density. Of late most of the chatter and technological developments seem to be focused on the meibomian glands. They are nice low hanging fruit (so to speak) and it's easy to understand why treating them has come into vogue. It's not really all that hard to get clinical improvement, at the end of the day. And the attention MGs are getting truly is long overdue.

And yet...

Where oh where is the PAIN coming from? When I think of the people doing all these glamorous boutique MGD treatments and not experiencing conclusive, lasting symptomatic improvement it makes me gnash my teeth.

We still really don't know our chickens from our eggs in the world of dry eye. Let's keep goblet cells and mucous in mind.

The conjunctival impression cytology between the diagnosed cases of dry eye and normal individuals.

Background:
The dry eye or tear film dysfunction is a common ophthalmic syndrome.

Objective:
To compare the results of conjunctival impression cytology between dry eye patients and normal individuals.

Subjects and methods:
A case control study including consecutive cases of dry eye syndrome was carried out. Individuals without dry eye were taken as control. Impression of conjunctiva with cellulose acetate filter paper was taken from inferonasal bulbar conjunctiva and was stained with Periodic Acid- Schiff (PAS) and counter-stained with haematoxylin and eosin. Main outcome measure: goblet cell density.

Results:
There was a female preponderance in dry eye disease. Of 114 dry eye cases, 49.2% eyes showed decreased or absent goblet cell density. In 72 normal individuals 73.7% eyes showed normal goblet cell density and 26.3% of eyes showed decreased or absent goblet cells (p less than 0.001). The tear break-up time (TBUT) test was significantly more likely to be less than 10 seconds in cases as compared to the controls ( OR = 19.36, 95% CI = 7.56 - 52.52). Similarly, the goblet cell density was likely to be significantly reduced in cases with dry eye syndrome (OR= 2.25, 95% CI = 1.26 - 4.02, p = 0.003).

Conclusion:
Goblet cell density significantly reduces in dry eye syndrome. The impression cytology is a useful test for the diagnosis of dry eye syndrome. Key words: impression cytology; conjunctiva; dry eyes; tear film.

Nepal J Ophthalmol. 2011 Jan;3(5):39-44. doi: 10.3126/nepjoph.v3i1.4277.
Shrestha E, Shrestha JK, Shayami G, Chaudhary M.
Consultant Ophthalmologist, Himalaya Eye Hospital, Pokhara, Nepal.