Abstract
Conjunctival epithelium was systematically investigated with impression cytology in clinically asymptomatic wearers of soft contact lenses who had been using their lenses for several years. Severe abnormalities were observed, which had so far only been seen in diseases of the ocular surface mainly in dry eye syndromes. All patients showed evidence of squamous metaplasia with distinctly enlarged, flattened cells without evidence of keratinization. They also showed frequent nuclear abnormalities, primarily a high percentage of snakelike-appearing condensations of nuclear chromatin (snakes). The goblet cell density observed was relatively low. Snakes were for the first time detected outside the known localization (upper bulbar conjunctiva, 12 o'clock position) and could be demonstrated throughout the whole bulbar conjunctival epithelium. It is suggested that the changes observed are due to chronic mechanical irritation by the contact lens, as indicated by their topographical distribution and as proven by their reversibility after omission of contact lens wear.
Similar content being viewed by others
References
Abdel-Khalek LMR, Williamson J, Lee WR (1978) Morphological changes in the human conjunctival epithelium. 1. In the normal elderly population. Br J Ophthalmol 62:792–799
Abdel-Khalek LMR, Williamson J, Lee WR (1978) Morphological changes in the human conjunctival epithelium. 2. In keratoconjunctivitis sicca. Br J Ophthalmol 62:800–806
Adams A (1979) The morphology of human conjunctival mucus. Arch Ophthalmol 97:730–734
Brewitt H, Sander H (1982) Hornhautbefunde nach Tragen von Kontaktlinsen. Z Prakt Augenheilkd 4:79–82
Egbert PR, Lauber S, Maurice DM (1977) A simple conjunctival biopsy. Am J Ophthalmo1 84:798–801
Gilbard JP (1985) Tear film osmolarity and keratoconjunctivitis sicca In: Holly FJ (ed) Proceedings. Ist International Tear Film Symposium, Lubbock, Texas, pp 127–137
Götz ML, Jaeger W, Kruse FE (1986) Impressionszytologie der Bindehaut. Eine nichtinvasive Untersuchungsmethode. 1. Technik der Entnahme. Fortschr Ophthalmol 83:31–33
Götz ML, Jaeger W, Kruse FE (1986) Impressionszytologie der Bindehaut. Eine nichtinvasive Untersuchungsmethode. 2. Lichtmikroskopische Befunde bei normaler Conjunctiva, bei Keratoconjunctivitis sicca und bei Kontaktlinsenträgern. Fortschr Ophthalmol 83:34–38
Greiner JV, Allansmith MR (1981) Effects of contact lens wear on the human conjunctival mucus system. Ophthalmology 88:821
Greiner JV, Covington HI, Korb DR, Allansmith MR (1978) Conjunctiva in asymptomatic contact lens wearers. Am J Ophthalmol 86:403–413
Holly FJ, Lemp MA (1971) Wettability and wetting of corneal epithelium. Exp Eye Res 11:239–250
Kessing SV (1966) Investigations of the conjunctival mucin. Acta Ophthalmo1 44:439–453
Kessing SV (1968) Mucus gland system of the conjunctiva. Acta Ophthalmol 95 [Suppl]:1–133
Knop E (1988) Impressionscytologische Untersuchung der Conjunctiva bei Trägern weicher Kontaktlinsen unter besonderer Berücksichtigung des “Snake-like-chromatin”. Dissertation, Hannover 1988
Knop E (1990) Employment of a BSE-detector system for demonstration of morphological nuclear changes. Beitr Elektronenmikr. Direktabb. Oberfl. 23:343–346
Knop E, Brewitt H (1989) Klinische Studie über Weflex 55 und das Pflegesystem Polyrinse. Contactologia 11:24–29
Knop E, Brewitt H (1990) Snakelike condensations of nuclear chromatin. Cell Biol Int Rep 14 [Suppl]:221
Koch JM, Waubke TN (1987) Impressionscytologie und ihr licht- und elektronenmikroskopisches Äquivalent bei Patienten mit Keratokonjunctivitis sicca. Fortschr Ophthalmol 84:446–449
Koch JM, Bornfeld N, Waubke TN, Wessing A (1988) Impressionszytologie der Bindehaut nach hochdosierter Brachytherapie maligner Melanome der Uvea mit 106 RU/106 RH-Applikatoren. Fortschr Ophthalmol 85:642–645
Kruse FE, Rohen JW, Götz ML, Schmitz W (1986) Impressionszytologie der Bindehaut. Eine nichtinvasive Untersuchungsmethode. 3. Der Einsatz von Rasterelektronenmikroskopie und Transmissionselektronenmikroskopie an impressionscytologischen Präparaten. Fortschr Ophthalmol 83:39–45
Lemp MA, Dohlman CH (1971) Dry eye secondary to mucus deficiency. Trans Am Acad Ophthalmol Otolaryngol 75:1223–1227
Lemp MA, Holly FJ, Shuzo I, Dohlman CH (1983) The precorneal tear film. I. Factors in spreading and maintaining a continuous tear film over the corneal surface. Arch Ophthalmol 83:89–94
Liotet S, Batellier C, Chaumeil C, Rault J (1987) Interet de l'empreinte conjonctivale en contactologie (Konjunctivale Impressionszytologie bei Kontaktlinsenanpassung). Contactologia 9D: 176–179
Marner K (1980) ‘Snakelike’ appearance of nuclear chromatin in conjunctival epithelial cells from patients with keratoconjunctivitis sicca. Acta Ophthalmol 58:849–853
Nelson JD, Wright JC (1984) Conjunctival goblet cell densities in ocular surface disease. Arch Ophthalmol 102:1049–1051
Nelson JD; Wright J (1985) Impression cytology of the ocular surface in keratoconjunctivitis sicca. In: Holly FJ (ed) Proceedings. 1st International Tear Film Symposium, Lubbock, Texas, pp 140–156
Nelson JD, Harverner VR, Cameron JD (1983) Cellulose acetate impressions of the ocular surface, dry eye states. Arch Ophthalmo1 101:1869–1883
Prause JU, Marner K (1985) Snakelike nuclear chromatin in imprints of conjunctival cells in patients with Sjögrens syndrome. In: Holly FJ (ed) Proceedings. Ist International Tear Film Symposium, Lubbock, Texas, pp 157–161
Ralph RA (1975) Conjunctival goblet cell density in normal subjects and in dry eye states. Invest Ophthal 14:299–302
Robbins SL (1974) Pathologic basis of disease. Saunders, Philadelphia London Toronto, pp 1214–1221
Rohen JW (1986) Zur funktionellen Morphologie der Conjunctiva. Fortschr Ophthalmol 83:13–24
Royer J, Tabatabay C, Deschamps F (1985) Empreinte conjonctivale dans le syndrome de keratoconjonctive seche. Klin Monatsbi Augenheilkd 186:513–514
Thatcher RW, Darougar S, Jones BR (1977) Conjunctival impression cytology. Arch Ophthalmol 95:678–681
Treumer H, Corfield A, Duncker G (1986) Reaktive Veränderungen der Bindehaut und Hornhaut unter Aphakie-Dauerkontaktlinsen: Analysen der Tränenflüssigkeit. Fortschr Ophthalmol 83:403–406
Tseng SCG (1985) Staging of conjunctival sqamous metaplasia by impression cytology. Ophthalmology 92:728–733
Tseng SCG, Hirst LW, Maumenee AE, Kenyon KR, Sun TT, Green R (1984) Possible mechanisms for the loss of goblet cells in mucin-deficient disorders. Ophthalmology 91:545–552
Author information
Authors and Affiliations
Additional information
Correspondence to: E. Knop
Rights and permissions
About this article
Cite this article
Knop, E., Brewitt, H. Conjunctival cytology in asymptomatic wearers of soft contact lenses. Graefe's Arch Clin Exp Ophthalmol 230, 340–347 (1992). https://doi.org/10.1007/BF00165942
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00165942