Cytologic changes seen in conjunctival cells from the eye of a patient may provide supportive evidence for the diagnosis of vitamin A deficiency. Makdani et al used a grading scheme for reporting these changes. The authors are from Lincoln University, CDC, Ramsey Clinic, Belize Vision Center and the Beltsville Human Nutrition Research Center.
Method: Conjunctival Impression Cytology with Transfer (CICT)
Parameters:
(1) epithelial cell size
(2) epithelial cell cytoplasm
(3) epithelial nuclear-to-cytoplasmic ratio
(4) number of goblet cells
(5) goblet cell features
Grade 0
Grade 1
Grade 2
Grade 3
epithelial cell size
small, round
slightly larger, more polygonal
larger, polygonal
large and polygonal
epithelial cell cytoplasm
eosinophilic staining
eosinophilic staining
variable staining
basophilic staining
epithelial cell N:C ratio
1:2
1:3
1:4 - 1:6
> 1:6
number of goblet cells
abundant
decreased
markedly decreased
very few or none
features of goblet cells
plump, oval, cytoplasm intense PAS+
plump, oval, cytoplasm intense PAS+
smaller, poorly defined cell border, less intense PAS
score for patient =
= ((grade for left eye) + (grade for right eye)) / 2
where:
• The scores for both eyes are supposedly closely correlated. I would think this means that the scores for both sides are +/- 1 grade.
Interpretation:
• minimum score: 0
• maximum score: 3
• A score < 1.5 is considered normal (since the values are whole numbers, this could be stated also as <= 1).
• A score >= 1.5 is considered abnormal (operationally this would be a score of >= 2 in at least 1 eye).
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