Haller-Schober et al developed an impression cytology (IC) score for patients with dry eye. The score can be used to monitor a patient with dry over time and any response to therapy. The authors are from Medical University Graz in Austria.
Patient selection: dry eye
Testing: impression cytology
Parameters:
(1) epithelial cell sheet
(2) degree of squamous metaplasia (based on nuclear to cytoplasmic ratio)
(3) degree of keratinization
(4) frequency of nuclear changes
(5) type of nuclear changes
(6) density of goblet cells
(7) morphology of goblet cells
(8) amount of mucus
(9) morphology/appearance of the mucus
(10) inflammatory cells
|
Parameter |
Finding |
Points |
|
epithelial cell sheet |
intact and dense |
0 |
|
|
slightly loosened |
1 |
|
|
definitely loosened |
2 |
|
|
single cells |
3 |
|
degree of squamous metaplasia |
none (N/C ratio 1:1 to 1:3) |
0 |
|
|
slight |
1 |
|
|
definite |
2 |
|
|
marked (N:C ratio > 1:10) |
3 |
|
degree of keratinization |
none |
0 |
|
|
low-grade |
1 |
|
|
distinct |
2 |
|
|
marked |
3 |
|
frequency of nuclear changes |
none |
0 |
|
|
few |
1 |
|
|
some |
2 |
|
|
abundant |
3 |
|
type of nuclear changes |
none |
0 |
|
|
pyknosis, condensation of chromatin (mild) |
1 |
|
|
snake-like chromatin |
2 |
|
|
nuclear fragmentation |
3 |
|
goblet cell density |
normal |
0 |
|
|
slightly reduced |
1 |
|
|
definitely reduced |
2 |
|
|
no or rare goblet cells |
3 |
|
goblet cell morphology |
normal |
0 |
|
|
abnormal/pathologic |
3 |
|
amount of mucus |
normal |
0 |
|
|
none |
1 |
|
|
medium |
2 |
|
|
abundant |
3 |
|
morphology of the mucus |
granular plaques |
0 |
|
|
0+ exudates |
1 |
|
|
0 or 1+ filaments |
2 |
|
|
1 or 2+ aggregation |
3 |
|
inflammatory cells |
none |
0 |
|
|
few |
1 |
|
|
some |
2 |
|
|
abundant |
3 |
where:
• The scoring for the amount of mucus may need revision.
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maxumum score: 30
• The higher the score the more abnormal the cytopathy.
Specialty: Ophthalmology, Immunology/Rheumatology
