title: Study of conjunctival goblet cell morphology and tear film stability in pseudoexfoliation syndrome.
abstract: BACKGROUND
  Tear secretion and tear film stability seem to be influenced by pseudoexfoliation syndrome (PEX). Histopathological evaluation of conjunctival goblet cells in PEX patients might explain the influence on tear film stability.
  
  
  METHODS
  In a prospective, cross-sectional study, 40 eyes of 40 patients with PEX (study group) had measurement of Schirmer test with anesthesia and break-up time prior to cataract surgery. At the end of an uneventful operation, a 1 x 1.5 mm sample of conjunctival tissue was obtained and light and electron microscopy were performed. Results were compared with a control group. Histology evaluation was masked. Primary outcome measures included Schirmer test with anesthesia, break-up time, goblet cell density and morphological character of conjunctiva and conjunctival goblet cells.
  
  
  RESULTS
  Both Schirmer test and break-up time values were significantly lower (P= 0.01 and P= 0.001) in the PEX patients (mean 10.6 mm and 8.6 s respectively) than in the control group (13.4 mm and 12.3 s respectively). The number of goblet cells in patients with PEX compared with the control group showed no statistically significant difference (P= 0.66). Use of trichrome stain revealed significant differences in the staining properties of goblet cells between patients with PEX and controls. On electron microscopy, typical pseudoexfoliation filaments were found in the connective tissue of conjunctiva of PEX patients. Remarkable changes of mucin pockets in the study group were also noticed; they had extremely irregular distribution, various forms of size and appearance and even complete collapse.
  
  
  CONCLUSIONS
  Pseudoexfoliation seems to alter basic features of goblet cell morphology, thus affecting tear film stability. Further studies are necessary to determine the exact mechanism.
authors.affiliation: Department of Ophthalmology, Heraklion University Hospital, PO Box 2208, 71003, Heraklion, Crete, Greece.
authors.forename: Vassilios P
authors.initials: VP
authors.lastname: Kozobolis
authors.forename: Emmanouil V
authors.initials: EV
authors.lastname: Christodoulakis
authors.forename: Irene I
authors.initials: II
authors.lastname: Naoumidi
authors.forename: Charalambos S
authors.initials: CS
authors.lastname: Siganos
authors.forename: Efstathios T
authors.initials: ET
authors.lastname: Detorakis
authors.forename: Loannis G
authors.initials: LG
authors.lastname: Pallikaris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000648:ultrastructure*; D003238:Connective Tissue / Q000648:ultrastructure; D003430:Cross-Sectional Studies; D017889:Exfoliation Syndrome / Q000378:metabolism / Q000473:pathology*; D005260:Female; D020397:Goblet Cells / Q000648:ultrastructure*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009077:Mucins / Q000648:ultrastructure; D011446:Prospective Studies; D013666:Tears / Q000378:metabolism*
chemical_list: D009077:Mucins