Impression conjunctival cytology in sicca syndrome - correlations between clinical and histological findings related to dry eye severity.

Keratoconjunctivitis sicca represents a progressive deterioration of ocular surface produced by a deficient secretion of lachrymal film (quantitative disorder) or excessive tear evaporation (qualitative disorder). The cytological analysis of conjunctival impression in 42 patients with dry eye syndrome established a strong correlation between the clinical grade of severity of disease and the grade of squamous metaplasia, including goblet cell loss. The cellular anomalies were represented by modifications of keratinization, epithelial cells' anisocytosis, anisochromia, the nuclear condensation and the cytoplasmic vacuolization. Pyknotic nuclei and anucleated cells were only seen in the most severe dry eye. The modifications in epithelial cells and conjunctival goblet cells reveal cellular sufferance, with an evident parallelism between these anomalies and clinico-functional signs in dry eye. Conjunctival impression provides an easy and quick identification of the lachrymal film alterations with high specificity and sensitivity, giving valuable information about the qualitative disorder.

[Normal tension glaucoma or syndrome of chronic ocular ischemia]. / Glaucom cu tensiune normala sau sindrom de ischemie soculara cronica?

Chronic ischemia related to a manifest ophthalmic artery stenosis, determines extremely rare ischemic chronic modifications at the level of the optic nerve, with progressive optic atrophy and visual fun ction alteration. It is presented the case of a 59 years patient, who was hospitalized in Clinic of Ophthalmology, Emergency Clinic Districtual Hospital, for decreased vision of the left eye. Fundus eye examination reveals normal aspect of papilla of the right eye and glaucomatous like modification of the left eye, confirmed by perimetry and OCT exams, which present typical glaucomatous lesions. Doppler examination revealed an enormous thrombus at the level of the left internal carotid, with more than 90% stenosis. In this context the diagnosis was chronic ocular ischemia, atypical form. lschemic ocular syndrome presents polymorphic clinic aspects, the most frequent are the ischemic lesions of posterior pole of the eye: retinal hemorrhages, neovascularization, ischemic edema, red cherry macula, cotton-wool spots. lschemic optic neuropathy is less frequent presented, and pseudo-glaucomatous lesion of optic nerve with papillary excavation is exceptional.