Ocular Surface Parameters in Celiac Disease

The Schirmer test, tear film break-up time evaluation, and conjunctival impression cytology will performe in addition to a complete ophthalmologic examination. Single assessment session is performed. The Schirmer's test was performed using a standardized kit containing a strip of filter paper 5×30-mm2 and placed on to the lower lid margin in a temporal position. The patient looked up and blinked normally for 5 minute before the strip was removed and the length of wetted paper measured. A value of <5 mm was taken as abnormal. The stability of the tear film over the conjunctiva and cornea was assessed using a Burton's lamp with a cobalt blue filter and sodium fluorescein. A drop of 2% sodium fluorescein was applied to the eye, and the patient was asked to blink five times so that a film is formed over the cornea and bulbar conjunctiva. The patient was then asked to refrain from blinking during which time black spots or lines begin to appear indicating dry spots. The interval (second) between the last blink and the first randomly distributed dry spot was taken as the tear break-up time. An average of three measurements was recorded. A value of <10 second was taken as abnormal. Impression cytology of the conjunctiva of the topically anaesthetized eye was performed according to the technique described by Nelson et al. Small disks of cellulose acetate filter paper (MFS, Advantec MFS, Pleasanton, USA, pore size 0.2 micrometer) were cut into pieces approximately 4×5-mm2 in size, placed on the superior nasal interpalpebral conjunctiva 5 mm from the limbus, gently pressed for 5 second, and then removed. The specimens were placed in a fixative solution and stained with Papanicolau's modification of Gill's technique. Single assessment session is performed in one hour.