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Conjunctival goblet cells and mitotic rate in children with retinol deficiency and measles
Insights
Retinol deficiency significantly increases conjunctival epithelial cell turnover and reduces goblet cells in children. Measles infection does not further alter these changes in retinol-deficient eyes.
Area of Science:
- Ophthalmology
- Nutritional Science
- Pediatrics
Background:
- Conjunctival epithelium health is crucial for ocular surface integrity.
- Retinol deficiency is a significant public health concern in developing countries, particularly affecting children.
- Measles can exacerbate ocular surface disease, but its specific impact on conjunctival epithelium in retinol deficiency is not fully understood.
Purpose of the Study:
- To investigate the effects of retinol deficiency and concurrent measles infection on the conjunctival epithelium in preschool children.
- To quantify changes in epithelial mitotic rate (MR) and goblet cell frequency (GCF) in response to these conditions.
Main Methods:
- Conjunctival biopsy specimens were analyzed from three groups of preschool children in India: normal, clinically retinol deficient, and clinically retinol deficient with measles.
- Epithelial mitotic rate (MR) and goblet cell frequency (GCF) were determined for each group.
- Serum retinol levels were measured in children with measles to differentiate between low and normal levels.
Main Results:
- Children with clinical retinol deficiency showed a significantly higher MR (15.4%) and lower GCF (1.0%) compared to normal controls (MR 1.3%, GCF 8.0%).
- In children with retinol deficiency and measles, MR remained elevated (9.0%-10.2%) and GCF low (1.9%-3.1%), regardless of serum retinol levels.
- These changes indicate conjunctival hyperproliferation in retinol deficiency, unaffected by measles co-infection.
Conclusions:
- Retinol deficiency, even without severe clinical signs like scarring, leads to significant hyperproliferation of the conjunctival epithelium.
- Concurrent measles infection does not appear to further alter the mitotic rate or goblet cell frequency in retinol-deficient conjunctiva.
- These findings highlight the profound impact of retinol deficiency on conjunctival cell dynamics.
Abstract:
To study the effect of retinol deficiency and measles on the conjunctival epithelium, we determined the epithelial mitotic rate (MR) and goblet cell frequency (GCF) in conjunctival biopsy specimens from preschool children in Hyderabad, India. We studied three groups of children: normal appearing, clinically retinol deficient (defined by the presence of superficial fine punctate keratitis), and clinically retinol deficient with measles. The last group was subdivided into those with low serum retinol levels (less than or equal to 20 micrograms/dL [less than or equal to mumol/L]) and those with normal serum retinol levels (greater than 20 micrograms/dL [greater than 0.70 mumol/L]). In the control group of seven normal-appearing children with a mean age of 4.6 years, the mean MR was 1.3% +/- 0.4%, and the mean GCF was 8.0% +/- 3.6% of the basal epithelial cells. In seven children with clinical retinol deficiency, the mean MR was 15.4% +/- 1.2%, and the mean GCF was 1.0% +/- 0.5%, values significantly different from normal ones. Among 11 children with clinical retinol deficiency, measles, and low serum retinol levels, the mean MR was 9.0% +/- 1.9%, and the mean GCF was 3.1% +/- 1.1%, values not statistically different from those in children with clinical retinol deficiency alone. Five children with clinical retinol deficiency, measles, and normal serum retinol levels had a mean MR of 10.2% +/- 3.7% and a mean GCF of 1.9% +/- 1.7%, values similar to those in the other disease groups. This indicates that retinol deficiency sufficient to cause clinical signs without subepithelial scarring or keratinization is associated with hyperproliferation of the conjunctiva whether or not there is a superimposed measles infection.