Abstract
To compare goblet cell (GC) number and area in the covered superior (SB) versus exposed temporal (TB) bulbar conjunctiva in control versus aqueous tear deficient eyes (ATD) and evaluate correlation with tear MUC5AC protein. SB and TB impression cytology performed on control eyes, Sjögren syndrome (SS) ATD, and non-SS ATD was stained with period acid Schiff. GC number and area were measured with image analysis software. Protein-normalized MUC5AC level was measured in Schirmer strip-collected tears. Compared to control conjunctiva, GC number and area were significantly lower in SS, non-SS, and combined ATD groups in exposed TB, and were also significantly lower in SS and combined ATD groups in covered SB. In all ATD, GC number and area were significantly correlated, but differences between SB and TB were non-significant. Normalized tear MUC5AC protein was lower in all ATD groups versus control eyes, and correlated only with GC area. GCs are significantly decreased in the covered and exposed conjunctiva in SS. GC area may be a better disease measure than number for ATD. Correlation between tear MUC5AC concentration and GC area suggests tear MUC5AC mucin can be used as a disease-relevant biomarker for conjunctiva GC health.
Highlights
Conjunctival goblet cell products are essential for maintaining tear stability and ocular surface immune tolerance[1,2,3]
The goblet cell number and area in the temporal bulbar (TB) and superior bulbar (SB) sites were compared between the aqueous tear deficient eyes (ATD) and control groups (Table 2)
In the SB conjunctiva, goblet number was significantly lower than control only in the Sjögren syndrome (SS) group, while SB goblet cell area was lower in the SS and all ATD groups
Summary
Conjunctival goblet cell products are essential for maintaining tear stability and ocular surface immune tolerance[1,2,3]. Studies utilizing conjunctival impression cytology, taken primarily from the exposed conjunctiva, have found a decrease in goblet cell number in aqueous tear deficiency (ATD) and ocular surface inflammatory diseases, such as Sjögren syndrome, Stevens Johnson Syndrome and graft-vs.-host disease (GVHD)[4,5,6,7,8,9]. The primary objective of this study was to compare goblet cell number and area in the non-exposed superior bulbar (SB) and exposed temporal bulbar (TB) conjunctiva to determine which site shows greater difference between control and dry eyes. A secondary objective is to determine if tear MUC5AC protein is reduced in ATD and correlates with goblet cell number or size in impression cytology and clinical severity markers
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