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   Table of Contents      
ARTICLE
Year : 1983  |  Volume : 31  |  Issue : 5  |  Page : 629-631

Cytodiagnosis of kerato-conjunctival lesions


State Institute of Ophthalmology, Govt. M.D. Eye Hospital, M.L.N. Medical College, Allahabad, India

Correspondence Address:
T N Agrawal
State Institute of Ophthalmology, Govt. M.D. Eye Hospital, M.L.N. Medical College, Allahabad
India
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Source of Support: None, Conflict of Interest: None


PMID: 6671778

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How to cite this article:
Agrawal T N, Srivastava D, Gupta S C. Cytodiagnosis of kerato-conjunctival lesions. Indian J Ophthalmol 1983;31:629-31

How to cite this URL:
Agrawal T N, Srivastava D, Gupta S C. Cytodiagnosis of kerato-conjunctival lesions. Indian J Ophthalmol [serial online] 1983 [cited 2019 Aug 19];31:629-31. Available from: http://www.ijo.in/text.asp?1983/31/5/629/36611


  Introduction Top


Recognizable cytomorphological alteration is one of the most important development in recent year. Biopsy of the lesion is still the only method for exact diagnosis but this is neither feasible nor practical as a diagnostic procedure in certain kerato-conjunctival lesions. Exfoliated cells from these lesions should offer alternative diagnostic technique. It is astound­ing that general cytomorphology at first set forth by Von Lipschultz did not receive more attention earlier.

Exfoliative cytology can be done in general out patient door rather than in separate clinic to avoid delay in therapy. Niether huge labora­tories nor expansive equipments are needed for cytological studies. An attempt is here being made to illustrate the role of cytological diagnosis. The present paper embodies cyto­logical diagnosis of Epidemic conjunctivitis-81 & to differentiate type of corneal ulcers.


  Material and Method Top


Fifty patients admitted for treatment of corneal ulcer & fifty patients attending O.P.D. for treatment of epidemic conjunctivitis at State Institute of Ophthal­mology at M.D. Eye Hospital, Allahabad, were studied. The cases were selected on the following basis:

(1) Corneal Ulcers­

(a) Bacterial ulcer

-30 cases

-Bacterial culture-positive

-Fungus culture- negative

(b) Fungal ulcer

-10 cases

-Bacterial culture-Negative

-Fungal culture -Positive

(c) Viral ulcer:­

-10 cases

-Bacterial culture -Negative

-Fungal culture -Negative

-Loup Examination-Dendritic pattern of ulcer.

(2) Epidemic Conjunctivitis-81

-50 Bilateral cases

-Bacterial culture - Negative

-Fungal culture - Negative

-No history of discomfort in eyes prior to disease.

From all above cases exfoliated cells were obtained with swab moistened with distilled water from lower fornix of the eye. The smear thus obtained were pro­cessed for following staining:­]

1- KOH preperation

2-H & E stain

3-Giemsa's stain

The smears were examined under light microscope for cytological studies.


  Observation and Conclusions Top


(I a Bacterial corneal ulcers

H. & E. stain-Pathogenic effect manifested as necrosis & lysis of cell due to pronounced toxic influences in these type of corneal ulcers.

Changes may be seen in cytoplasm & nucleus. In cytoplasm there may be an altered staining reaction, increased granularity. Nucleus en­larges with blurred chromatin & vacuolation appears. There may be an apparant thickening of nuclear membrane due to accumulation of chromatin. These changes gradually increases resulting in necrosis of the cell. Majority of the cells were enlarged & vacuolated. Macro­nucleus & irregular chromatin were present.

Presence of bacteria in 80% cases is pathognomic. Smear tests have revealed the preponderance of polymorphs in these type of ulcers.

(I b) Fungal Corneal Ulcers

KOH preperation-out of 10 fungus positive cases 4 case (40%) were KOH positive. Specific fungus present were Aspergillus fumigatus and candida albicans. Candida nay be recognized by its characteristic budding or spore bearing mycelia.

H & E stain-Smear test have shown inflammatory reaction in this variety of corneal ulcer. This include necrosis of epithelial cells, pus cells in preponderance & presence of polymorphs & lymphocytes. Giemsa's stain is stain is insignificant.

(I c) Viral Corneal Ulcers

Giemsa's stain-Herpes group virus' has intranuclear inclusion bodies & stains blue. This property has been used as a criterion to diagnose the disease.

H & E stain---Ballooning degeneration is found in epithelial cells. Inclusion in herpes is homogeneous material appears filling the centre of nucleus & stain bluish. Later inclusion shrinks to pink staining object surrounded by halo which separates it from marginated chromatin. Preponderance of mononuclear cellular response strongly suggests of viral etiology. Giant cell formation is pronounced in virus of herpes group due to lipid contents which involve in cell fusion. KOH preparation­-Insignificant.

2-Epidemic Conjunctivitis-81

Giemsa's stain-Epithelial cells showed intranuclear inclusion bodies & stain blue.

H & E stain-Balooning degeneration was found in epithelial cells. Inclusions were intra­nuclear & stain bluish. Preponderance of mononuclear cells was also suggestive of viral etiology. Giant cell formation was also pronounced.

KOH preperation-Insignificant.

On above observations it is concluded, that cytological examination is a simple & useful diagnostic aid & should be routinely performed.


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]



 

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