CORRELATION OF GOBLET CELL-DENSITY AND MUCOSAL EPITHELIAL MEMBRANE MUCIN EXPRESSION WITH ROSE-BENGAL STAINING PATIENTS WITH OCULAR IRRITATION

Purpose: This study was designed to compare goblet cell densities and mucosal epithelial membrane mucin (MEM) expression in impression cytol ogy specimens obtained from control subjects and patients with one of the following clinically defined diseases: aqueous tear deficiency (AT D) associated with Sjogren syndrome, ATD not associated with Sjogren s yndrome, inflammatory Meibomian gland disease associated with rosacea, and Meibomian gland atrophy. These data were correlated with ocular s urface rose Bengal staining scores, Schirmer scores, and HLA-DR antige n staining of conjunctival epithelial cells. Methods: Goblet cell dens ity and MEM expression were studied by impression imprints with immuno histochemical staining using an anti-mucosal epithelial membrane mucin antibody in the temporal and inferior bulbar and inferior tarsal conj unctiva of study subjects. Results: Goblet cell density adjacent to th e temporal limbus was significantly reduced at 3 mm posterior to the t emporal limbus in both aqueous tear deficiency groups compared with th e other groups and in patients with Sjogren syndrome compared with all other groups. In the inferior tarsus, goblet cell density was signifi cantly reduced in patients with non-Sjogren syndrome ATD as compared w ith all other groups, except those with inflammatory Meibomian gland d isease. Mucosal epithelial membrane mucin expression in the bulbar and tarsal conjunctiva was absent in a greater percentage of patients wit h Sjogren syndrome compared with all other groups. Total ocular surfac e rose Bengal staining scores were significantly higher in patients wi th Sjogren syndrome as compared with all other groups and in patients with non-Sjogren syndrome ATD as compared with control groups. Rose Be ngal staining scores and Schirmer I test results (without anesthesia) were inversely correlated with bulbar, but not tarsal, conjunctival go blet cell densities, and with the absence of bulbar conjunctival MEM e xpression. Conclusions: These results suggest that reduced goblet cell density and mucosal epithelial cell mucin expression could explain in creased rose Bengal staining in patients with aqueous tear deficiency. In addition, MEM may be regarded as a marker for normal differentiati on of ocular surface epithelia, with its absence signifying the develo pment of squamous metaplasia.