Cytological Evaluation of Adenoviral Follicular Conjunctivitis by Cytobrush

Abstract

Conjunctival brush samples from 38 patients with acute conjunctivitis were examined to determine whether cellular features could be utilized for cytodiagnosis. Of all cases, 32 (84%) patients showed a characteristic cell pattern for adenoviral follicular conjunctivitis (AFC) and in the remaining 6 (16%) patients herpetic infection was suggested cytologically. The background of the conjunctival smears from patients with AFC was characterized by the predominance of lymphocytes with little fibrinous discharge. In addition, two types of nuclear alterations were demonstrated i.e. intranuclear inclusions and a so-called ground-glass nuclear appearance. Ground-glass nuclei occurred more frequently than intranuclear inclusions in patients with AFC. However, the presence of lymphocytes in conjunctival smears was a useful criterion for making the differential diagnosis between herpetic and adenoviral infections. Thus, in the absence of these three cellular changes, i.e. ground-glass nuclei, intranuclear inclusions and lymphocytic background, infectious conditions other than AFC may be considered, regardless of the numbers of conjunctival cells present. Emphasis is placed on the value of conjunctival brush cytology for the rapid diagnosis of cases of suspected AFC.