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Updated: Aug 11, 2026
Impression Cytology of the Lid Wiper Area
Published on: August 9, 2016
Flow cytometry in conjunctival impression cytology: a new tool for exploring ocular surface pathologies
Françoise Brignole-Baudouin1, Ann-Christin Ott, Jean-Michel Warnet
1Laboratory of Toxicology, Faculty of Pharmaceutical and Biological Sciences, University of Paris-5 René Descartes, Paris, France.
Insights
Flow cytometry (FCM) offers a novel approach to analyze ocular surface cells, aiding in the diagnosis and understanding of conditions like Sjögren
Area of Science:
- Ophthalmology
- Immunology
- Cell Biology
Background:
- Flow cytometry (FCM) is a versatile technique increasingly applied beyond immunology and hematology.
- Ocular surface investigations benefit from FCM for analyzing cell biology and pathophysiology.
- Impression cytology enables non-invasive collection of ocular surface cells for FCM analysis.
Purpose of the Study:
- To explore the application of FCM in analyzing ocular surface cells obtained via impression cytology.
- To investigate pathways such as apoptosis, cell lineage, immune markers, cytokine production, drug resistance, and oxidative stress in ocular surface conditions.
- To evaluate the utility of FCM in understanding ocular surface diseases and the effects of topical treatments.
Main Methods:
- Conjunctival cells collected using non-invasive impression cytology.
- Cells fixed and dissociated for subsequent processing.
- Immunostaining followed by flow cytometry (FCM) analysis.
Main Results:
- FCM analysis revealed inflammatory and apoptotic patterns in patients with dry eye disease (keratoconjunctivitis sicca).
- Studies identified similar patterns in patients undergoing long-term antiglaucoma medication, even without clinical inflammation signs.
- Confirmed the presence of inflammatory and apoptotic markers in ocular surface cells.
Conclusions:
- Flow cytometry combined with impression cytology is valuable for studying ocular surface pathophysiology.
- This technique aids in understanding conditions like Sjögren's syndrome, ocular allergy, and drug toxicity.
- FCM facilitates large clinical trials, drug monitoring, and assessment of topical medication efficacy and safety.
Abstract:
Flow cytometry (FCM) is a widely used technique, not only in immunology and hematology but also in many other domains and new applications have been developed in ophthalmology, for investigating ocular surface biology and pathophysiology. Apoptosis, proteins specific of cell lineage, expression of activation or immune-related markers, proinflammatory cytokine production, multi-drug resistance and oxidative stress are some examples of possible pathways that may be explored directly using ocular surface cells removed with the non-invasive technique of impression cytology, by means of flow cytometry. Conjunctival cells are thus collected by impression cytology on a filter, fixed in paraformaldehyde and dissociated by agitation before immunostaining and FCM processing. Important observations have been made concerning Sjögren's syndrome, ocular allergy and antiglaucoma eye drop toxicity. Studies performed on impression cytology with FCM techniques confirmed inflammatory and apoptotic patterns in a large number of patients with keratoconjunctivitis sicca or receiving long-term treatments with antiglaucoma drugs, even though they did not present any clinical signs of inflammation. FCM may now be used for large multicenter clinical trials and has already contributed to a better understanding of ocular surface pathophysiology, the monitoring of new immunomodulating drugs and knowledge concerning topical drugs, as regards both efficacy and safety.
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