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Updated: Aug 18, 2026
Impression Cytology of the Lid Wiper Area
Published on: August 9, 2016
Impression cytology for detection of clinically suspected ocular surface disorders: A cross-sectional study
Seyed Mohamadmehdi Moshtaghion1, Mohammad Abolhosseini1, Mozhgan Rezaei Kanavi2
1School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Impression cytology (IC) shows substantial agreement with clinical diagnoses of ocular surface lesions. This non-invasive method is valuable for differentiating benign from malignant conditions.
Area of Science:
- Ophthalmology
- Cytopathology
Background:
- Ocular surface lesions encompass a range of conditions, from dry eye to malignancies.
- Accurate diagnosis is crucial for effective treatment and patient outcomes.
Purpose of the Study:
- To investigate the diagnostic accuracy of impression cytology (IC) for various ocular surface lesions.
- To assess the agreement between clinical suspicions and IC findings over a 14-year period.
Main Methods:
- A retrospective review of IC findings from 2005-2018 in a referral center.
- Calculation of Cohen's Kappa coefficient (CKC) to evaluate agreement between clinical suspicions and IC results.
- Comparison of IC results with histopathologic data where available.
Main Results:
- The most common suspected diagnoses were ocular surface squamous neoplasia (42.0%) and limbal stem cell deficiency (36.3%).
- Overall agreement between clinical suspicion and IC was substantial (CKC=0.68), with near-perfect agreement for Acanthamoeba keratitis (CKC=0.966) and benign pigmented lesions (CKC=0.843).
- IC results showed strong correlation with histopathology (CKC=0.86).
Conclusions:
- Impression cytology demonstrates substantial agreement with clinical diagnoses of ocular surface disorders.
- IC is a valuable, non-invasive tool for diagnosing ocular surface diseases, particularly for distinguishing malignant from benign lesions.
- IC findings correlate well with histopathologic data, supporting its clinical utility.
Purpose:
Investigating impression cytology (IC) results of various types of clinically suspected ocular surface lesions over a 14-year period in a referral center in Iran.
Methods:
IC findings obtained from patients with different types of ocular surface disorders between 2005 and 2018 were reviewed. Agreement between clinical suspicions and IC results was evaluated by calculating Cohen's Kappa coefficient (CKC).
Results:
Clinical suspicions in 688 surveyed eyes were ocular surface squamous neoplasia (OSSN, 42.0%), limbal stem cell deficiency (LSCD, 36.3%), dry eye-related disorders (DERD, 11.5%), Acanthamoeba keratitis (AK, 7.2%), benign pigmented lesions (BPL, 1.9%), immune-related conjunctivitis (IRC, 0.7%), and malignant pigmented lesions (MPL, 0.4%). General agreement between clinical suspicions and IC results was 0.68 for all groups. This agreement was almost perfect in AK (CKC = 0.966) and BPLs (CKC = 0.843), and was substantial in MPLs (CKC = 0.749), OSSNs (CKC = 0.684), and LSCD (CKC = 0.612). CKC in IRC (0.567) and DERDs (0.443) was moderate. Histopathologic results were available in 22 eyes and were well-correlated with corresponding IC results (CKC = 0.86). Multiple post-treatment follow-up sessions of IC were performed in 51 eyes (11.4%) that had diagnosis of LSCD (31), OSSN (17), and MPL (3) at the first IC session.
Conclusion:
Our survey not only demonstrated an overall substantial agreement between IC results and primary clinical suspicions, but also showed an almost perfect correlation between IC results and existent histopathologic data. Therefore, IC as a non-invasive diagnostic modality can be of great importance in proper diagnosis of various ocular surface diseases especially when distinguishing malignant from benign lesions is required.
