CONJUNCTIVAL EPITHELIAL-CELL HYPERMITOSIS AND GOBLET CELL HYPERPLASIAIN ATOPIC KERATOCONJUNCTIVITIS

Atopic diseases that include eczema (atopic dermatitis), asthma, and s easonal and perennial rhinoconjunctivitis are common manifestations of abnormal immediate hypersensitivity. Ocular involvement, such as atop ic keratoconjunctivitis, characteristically includes conjunctival and corneal inflammation, and in a severe form, conjunctival scarring, sym blepharon, corneal epitheliopathy, and visual loss. To examine the con junctival cellular abnormalities in atopic keratoconjunctivitis, we st udied the in vivo differentiation and tissue-culture growth characteri stics of conjunctiva from normal subjects and patients with severe ato pic keratoconjunctivitis. We examined conjunctival biopsy specimens to determine epithelial mitotic rate and goblet cell frequency, and we s tudied conjunctival explants to determine the latent period for fibrob last outgrowth and fibroblast doubling time. The mitotic rate for atop ic keratoconjunctivitis, 6.7% +/- 2.1% (11 patients), was statisticall y significantly greater than for normal subjects, 2.0% +/- 0.63% (seve n subjects) (P = .05). Also the goblet cell frequency for atopic kerat oconjunctivitis, 14.6% +/- 3.4% (11 patients), was statistically signi ficantly greater than for normal subjects, 4.8% +/- 0.92% (seven subje cts) (P = .02). The latent period for fibroblast out-growth and the fi broblast doubling time for atopic keratoconjunctivitis were not statis tically significantly different from normal control subjects. Therefor e, atopic keratoconjunctivitis was associated with conjunctival epithe lial hypermitosis, goblet cell hyperplasia, and normal fibroblast tiss ue-culture growth. These characteristics may be useful in the diagnosi s of atopic keratoconjunctivitis. We previously studied another diseas e characterized by chronic conjunctival inflammation and scarring, cic atricial pemphigoid, which also demonstrated conjunctival epithelial h ypermitosis, but in contrast there was near absence of goblet cells, a nd the fibroblasts were hyperproliferative. These differences may be u sed to distinguish atopic keratoconjunctivitis from cicatricial pemphi goid.