Mi. Roat et al., CONJUNCTIVAL EPITHELIAL-CELL HYPERMITOSIS AND GOBLET CELL HYPERPLASIAIN ATOPIC KERATOCONJUNCTIVITIS, American journal of ophthalmology, 116(4), 1993, pp. 456-463
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.