Conjunctival impression cytology for the diagnosis, follow-up, and treatment in a patient with severe keratoconjunctivitis caused by alkali injury

Abstract

Purpose: To report a case of severe keratoconjunctivitis after chemical exposure that was treated by a conjunctival-limbal autograft transplantation according to conjunctival impression cytology (CIC) results.

Methods: A 48-year-old woman was diagnosed with a severe keratoconjunctivitis developed after exposure to a mixture of abrasive cleaning agents. Based on CIC results, decision to perform a limbal-conjunctival autotransplantation from the contralateral eye was taken after conventional topical treatment failed to improve symptoms. Polyethersulfone papers were used to take samples from the superior and inferior bulbar conjunctiva of affected and contralateral eyes, and Periodic acid Schiff's (PAS) staining was used to reveal the status of goblet cell (GC) population of the conjunctiva.

Results: Tearing, burning sensation, keratitis, squamous metaplasia, and GC improved noticeably, as observed by CIC, after autotransplantation.

Conclusions: CIC helped on the diagnosis, treatment decision, and follow-up of a patient severely affected by alkali exposure by checking the status of GC in the conjunctiva. Limbal-conjunctival autotransplantation decision was taken and performed consequently, and a significant improvement was observed through a follow-up by CIC.