Impression cytology implicates cell autophagy in aqueous deficiency dry eye

PURPOSE: Impression cytology in combination with a cell autophagy marker was used to demonstrate the utility of a novel frozen section technique, to assess the health of the ocular surface, as well as to correlate autophagic cell death with the commonly used clinical tests for dry eye. METHODS: Female patients over the age of 18 years who attended an outpatient ophthalmology clinic were invited to participate. Schirmer's test, tear film break-up time and the ocular surface disease index questionnaire were used as objective and subjective clinical tests for dry eye. The cellular biomarker microtubule-associated protein light chain 3 (LC3) was used as a marker of autophagic cell death. RESULTS: Low LC3 nuclear staining was positively correlated with Schirmer's test <10 mm. No correlation was found between other clinical tests for dry eye. CONCLUSION: This study demonstrates a positive linear relationship between Schirmer's testing and LC3. There is a lack of correlation between the commonly used diagnostics tests for dry eye, highlighting our incomplete understanding and assessment of dry eye.