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)



(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



1:4 - 1:6

> 1:6

number of goblet cells



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



• The scores for both eyes are supposedly closely correlated. I would think this means that the scores for both sides are +/- 1 grade.



• 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).


To read more or access our algorithms and calculators, please log in or register.