Crystalline Structure of Lacrimal Fluid During Goblet Cell Transformation of Squamous Epithelium of Pterygium at Various Clinical Stages.

PURPOSE: To identify the features of the crystalloscopic picture of native tears and goblet cell transformation of squamous epithelial cells of the pterygium at various clinical stages in young patients. PATIENTS AND METHODS: Native tears and surgical material from 26 patients with different clinical stages of pterygium aged 18-38 years. Tears for crystallography were obtained by capillary collection. Pterygium biopsies obtained intraoperatively were subjected to traditional histological processing with embedding in paraffin blocks with subsequent staining of histological sections with hematoxylin and eosin. Crystalloscopy of lacrimal fluid and microscopy were performed on an Olympus microscope with software for microphotography and image archiving. RESULTS: Crystallization of native tears of patients with pterygium differs from crystallization of tears of healthy individuals, and the crystalloscopic picture of tears changes as the disease progresses. Destruction of crystalline structures of native tears begins already in the second clinical stage of pterygium, when pronounced goblet cell transformation of squamous epithelial cells develops in the pterygium epithelium. However, as pterygium growth increases to the third and fourth clinical stages, the number of goblet cells decreases, and destructive processes in the crystalloscopic picture of native tears, on the contrary, progress, leading to an increase in the number of mucous inclusions in the crystallogram of native tears. The volume fraction of goblet cells differed significantly between clinical stages (Kruskal-Wallis test, p < 0.05), with the highest values observed at the second clinical stage. CONCLUSION: Crystallization of native tears differs by clinical stage of pterygium and parallels stage-dependent changes in goblet cell distribution. In the second clinical stage, the marked increase in goblet cell volume fraction and early crystal dissociation are hypothesized to reflect altered mucin secretion occurring against a background of chronic inflammation and microcirculatory disturbance; however, as mucin composition and microcirculation were not directly assessed in this study, this interpretation remains speculative and requires biochemical and functional confirmation.