Chapter 24 ■ Ophthalmic Specimen Collection 133

c. Swab off excess discharge.

d. Take scraping 2 mm from eye margin. (Normal

keratinized epithelium from the lid margin may

confound results of smear.)

e. Pass spatula two to three times in the same direction,

avoiding bleeding.

f. Spread specimen from spatula gently into a monolayer on a clean glass slide and label.

g. Fix smears as required for proposed smears and nonculture Chlamydia tests.

h. Repeat with separate sterile spatula on second eye.

G. Interpretation of Conjunctival

Cytology

1. Cellular reaction

a. Polymorphonuclear reaction

(1) Bacterial infections

(2) Chlamydial infection

(3) Very severe viral infection

b. Mononuclear reactions: Viral infection

c. Eosinophilia and basophilia: Allergic states

d. Plasma cells: Chlamydial infection

2. Intraepithelial cell inclusions

a. Chlamydial infection

(1) Acidophilic inclusions in cytoplasm, capping

epithelial cell nuclei

(2) Basophilic “initial bodies” in cytoplasm

b. Viral infection

 Giant, multinucleated epithelial cells may be

seen (e.g., herpetic keratoconjunctivitis).

H. Complications of Scraping

1. Conjunctival bleeding

a. Mild conjunctival bleeding, usually self-limiting,

frequently occurs.

b. Instill erythromycin ophthalmic ointment.

2. Corneal injury

a. Keep the spatula blade flat against the tarsal conjunctiva at all times to avoid trauma to the cornea.

b. Corneal injury is confirmed by a staining defect on

fluorescein staining.

c. If corneal injury occurs, instill erythromycin ophthalmic ointment and contact an ophthalmologist.

3. Transfer of infection from infected to noninfected eye

 This complication is avoided by using separate sterile instruments when taking samples from each eye.

4. Ocular irritation, pain, photophobia, lacrimation,

swelling, and hyperemia

 These problems are usually mild and self-limited.

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