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Updated: Jun 18, 2026
Impression Cytology of the Lid Wiper Area
Published on: August 9, 2016
Impression cytology findings in bullous keratopathy
Fabiana dos Santos Paris1, Eliana Domingues Gonçalves, Jeison de Nadai Barros
1Federal University of São Paulo, Marília-SP, Brazil. dra@fabianaparis.com.br
Insights
Symptomatic bullous keratopathy (BK) frequently shows squamous metaplasia and limbal stem cell deficiency (LSCD). Goblet cells on the cornea suggest LSCD in advanced BK cases.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Cell Biology
Background:
- Bullous keratopathy (BK) is a severe corneal condition.
- Understanding the cytological features of advanced BK is crucial for effective management.
Purpose of the Study:
- To evaluate the cytological characteristics of the central corneal epithelium in patients with symptomatic bullous keratopathy (BK) using impression cytology (IC).
- To assess the prevalence of squamous metaplasia and goblet cells, indicative of limbal stem cell deficiency (LSCD), in BK patients.
Main Methods:
- Impression cytology (IC) was performed on the central cornea of 72 eyes with symptomatic BK.
- Patients were categorized based on the presence (group GC) or absence (group NGC) of goblet cells.
- Limbal stem cell deficiency (LSCD) was diagnosed by the presence of goblet cells; squamous metaplasia was graded.
Main Results:
- All patients (100%) exhibited epithelial squamous metaplasia.
- Conjunctival goblet cells were present in 34.72% of eyes, suggesting LSCD.
- Corneal neovascularization was observed in 82.11% of eyes.
Conclusions:
- Squamous metaplasia is a consistent finding in advanced BK.
- The presence of goblet cells in a significant proportion of BK patients indicates that limbal stem cell deficiency (LSCD) is common in advanced stages of the disease.
Aim:
To evaluate, by impression cytology (IC), the cytological features of the central area of corneal epithelial surface of patients with symptomatic bullous keratopathy (BK). Design Cross-sectional observational case series.
Methods:
IC of the central cornea was performed in 72 eyes of 72 patients with symptomatic BK between June 2005 and December 2006. Patients were divided into two groups according to the presence (group GC) or not of goblet cells (group NGC). The diagnosis of limbal stem cell deficiency (LSCD) was defined by the presence of one or more intact goblet cells on the corneal surface. Squamous metaplasia was classified according to Murube and Rivas.
Results:
Epithelial squamous metaplasia was found in 72 (100%) eyes, along with conjunctival goblet cells in 25 (34.72%) eyes. Squamous metaplasia was grade 1 in group GC and more advanced grades in group NGC. Corneal neovascularisation was present in 62 (82.11%) eyes. Vessel measure was more than 4 mm in 11 eyes (23.4%) in group NGC and 10 eyes (40%) in group GC (p=0.559), and they were mostly subepithelial in 23 eyes (48.9%) in group NGC and 12 (48%) eyes in group GC (p=0.822).
Conclusion:
Squamous metaplasia was the most frequent finding associated with advanced BK. The presence of goblet cells on the surface of corneas with squamous metaplasia grade 1, in a significant number of patients, suggests that limbal stem cell deficiency is a common condition associated with advanced cases of BK.
