Conjunctival impression cytology and tear-film changes in cases with vitamin D deficiency

Int Ophthalmol. 2020 Jul;40(7):1687-1694. doi: 10.1007/s10792-020-01336-1. Epub 2020 Mar 23.


Purpose: To evaluate conjunctival surface cells and tear-film functions in cases with vitamin D deficiency.

Methods: Thirty-six patients with serum vitamin D deficiency and 27 control subjects with normal serum vitamin D levels were included in this prospective study. The tear break-up time (TBUT), Schirmer II test, and conjunctival impression cytology tests were performed to all participants.

Results: The mean serum vitamin D levels were 10.5 ± 5.0 µl in the study group and 33.9 ± 11.7 µl in the control group (p < 0.001). The median TBUT scores were 11 s and 17 s and the median Schirmer II values were 7.5 mm and 12 mm in the study and the control groups, respectively (p = 0.003, p = 0.049). According to the Nelson staging system, 69.4% of the patients in the study group had grade 2 or 3 impression cytology, whereas 18.5% of the participants in the control group had grade 2 or 3 impression cytology (p < 0.001).

Conclusion: Our study results showed that vitamin D deficiency may lead to dry eye causing conjunctival squamous metaplasia and loss of goblet cells on the ocular surface.

Keywords: Conjunctival impression cytology; Dry eye; Schirmer test; Tear break-up time; Vitamin D deficiency.

MeSH terms

  • Case-Control Studies
  • Conjunctiva
  • Dry Eye Syndromes* / diagnosis
  • Dry Eye Syndromes* / etiology
  • Goblet Cells
  • Humans
  • Prospective Studies
  • Tears
  • Vitamin D Deficiency* / complications
  • Vitamin D Deficiency* / diagnosis