IMPRESSION CYTOLOGY IN ATOPIC-DERMATITIS

Purpose: This study aimed to describe the ocular surface disorder in p atients with atopic dermatitis (AD). Design: A prospective case-contro lled study. Participants: A total of 44 patients with active AD seen a t Kobe University School of Medicine, Department of Ophthalmology, dur ing 1994 through 1996 and 22 normal control subjects were studied. Int ervention: The subjects underwent routine ophthalmic examinations, tea r film break-up time (BUT), Schirmer test, and conjunctival impression cytology. Main Outcome Measures: Patients and control subjects were c ompared for tear function parameters, goblet cell density, and conjunc tival squamous metaplasia grade. The relation of duration and recurren ces of AD to the ocular surface disorder also was looked for. Results: The duration of atopic disease ranged from 18 to 32 years (mean, 22.8 years). The average for exacerbations was 4.5 times. Chronic allergic conjunctivitis with superficial punctate keratitis was the most frequ ent clinical presentation. The BUT and Schirmer test values were signi ficantly lower in patients with AD compared with those of the control subjects. Impression cytology showed goblet cell loss and conjunctival squamous metaplasia, both of which related to the number of recurrenc es of AD rather than the duration of disease. Facial atopy and allergi c keratoconjunctivitis (AKC) related to the metaplasia of the ocular s urface (P < 0.001). Patients with reduced goblet cell density also sho wed low BUT levels (P < 0.001). Conclusion: Ocular surface disorder of AD characterized by goblet cell loss and conjunctival squamous metapl asia seemed to evolve independently of the duration of disease but wor sen with increased number of flare-ups. Direct epithelial damage by th e allergic reaction, disorder of tear quality, and quantity may be imp ortant in the genesis of the atopic ocular surface disease.