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Updated: Jun 25, 2026
Impression Cytology of the Lid Wiper Area
Published on: August 9, 2016
Impression Cytology as a Diagnostic Tool for Ocular Surface Squamous Neoplasia: An Exploratory Case Series From a
Arti Agarwal1, Sanjeev Kumar Singh1, Roopak Aggarwal1
1Department of Pathology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India.
Background:
Ocular surface squamous neoplasia (OSSN) presents diagnostic challenges in resource-limited rural settings where access to histopathology is constrained. This exploratory study evaluates the feasibility and clinical utility of impression cytology (IC) as a non-invasive diagnostic approach for OSSN in a rural Indian tertiary care center.
Methods:
We conducted a retrospective analysis of seven patients with clinically suspected OSSN. IC was performed using cellulose acetate filter paper (0.22 μm pore size) applied to the lesion surface for 5-10 s. For each lesion, separate samples were collected: one fixed immediately in 95% ethanol for Hematoxylin and Eosin (H&E) staining, and one air-dried followed by methanol fixation for May-Grünwald-Giemsa (MGG) staining. Cytological assessment focused on cellular atypia, nuclear-cytoplasmic ratio, pleomorphism, and chromatin pattern. Clinical management and outcomes were correlated with IC findings.
Results:
IC provided adequate cellular samples in all cases, enabling cytological grading across the OSSN spectrum: mild dysplasia (3 cases), high-grade dysplasia (3 cases), and cytological features suspicious for possible invasive squamous cell carcinoma (1 case). In cases treated with topical mitomycin C (MMC) based on IC guidance, complete lesion resolution was achieved at last follow-up (ranging from 3 to 6 months) without recurrence. Histopathological confirmation was available in 3 cases (including the case suspicious for invasion) and showed complete concordance with IC findings. The procedure was well-tolerated with 100% patient compliance.
Conclusion:
Impression cytology is a feasible, minimally invasive diagnostic tool for OSSN that can identify dysplastic changes and guide clinical management in resource-limited settings. While it cannot definitively diagnose stromal invasion and histopathological confirmation remains necessary when invasion is suspected, IC serves as a useful screening and monitoring modality in rural healthcare environments. Larger prospective studies are needed to validate these preliminary findings.
