The Dry Eye Zone

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Abstract: About that corneal staining....

Polycarbonate membrane impression cytology: evidence for fluorescein staining in normal and dry eye corneas.
Br J Ophthalmol. 2010 Apr;94(4):406-9.
Thinda S, Sikh PK, Hopp LM, Glasgow BJ.
Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

BACKGROUND/AIMS: Corneal impression cytology is usually performed with mixed cellulose ester membranes and a limited array of stains. A method using polycarbonate membrane air-dried preparations led to the discovery of fluorescein staining in cells from patients with and without dry eye disease and a membrane-induced defect that was not due to cell removal.

METHODS: Impressions after fluorescein installation were performed using polycarbonate and mixed cellulose ester membranes with rapid staining protocols for Diff-Quick as well as haematoxylin and eosin stains. Prior to staining the air-dried material was examined for fluorescence.

RESULTS: Epithelia of both normal and dry eye corneas retained fluorescence from clinical instillation of fluorescein. Corneal defects created by the polycarbonate membrane could not be explained by membrane-induced cell removal. After rapid staining, polycarbonate membranes revealed less background, dissolved easily prior to coverslip application, but showed lower cellular yield compared with the mixed cellulose membranes.

CONCLUSION: Polycarbonate membrane impression cytology enables immediate assessment with rapid stains. Topically applied fluorescein penetrates corneal epithelial cells in both normal and dry eye patients. Cells fluoresce on the cytology membranes. The impression-induced defect on the cornea is not due to cell stripping and may represent removal of mucins.