Conjunctival impression cytology, ocular surface and tear-film changes in patients with lichen planus

Summary Background.  Lichen planus (LP) is an immune-mediated chronic mucocutaneous disease. Rarely, LP affects the conjunctiva, resulting in conjunctival inflammation, cicatrization and scarring of the subepithelium and cornea, causing keratitis and keratoconjunctivitis sicca. To date, there has been no case–control study examining the ocular findings in LP. Aim.  To assess ocular surface health and tear-film changes in patients with LP. Methods.  In total, 20 patients and 24 healthy controls were enrolled in the study. Ocular surface changes were evaluated by conjunctival impression cytology, while tear-film functions were measured by the Schirmer test, break-up time, and fluorescein and lissamine green scoring. Results.  There was a significant difference in Schirmer test results, conjunctival lissamine green staining scores, and conjunctival impression-cytology grades between the groups. Conclusions.  LP may cause ocular surface changes and reduction in tear production, therefore it seems reasonable to evaluate these patients for symptoms and signs of dry-eye disease. We consider that LP should be included in the differential diagnosis of dry-eye disease, as this has important therapeutic and prognostic implications.