To the Editor.
—Kinoshita et al1 should be congratulated for further elucidating some aspects of ocular surface disease. Their use of a more sensitive indicator for mucinlike glycoproteins is a distinct step forward. The fact that this type of material is seen in the tears of patients with significantly decreased conjunctival goblet cells is interesting. The authors, however, correctly point out that these measurements do not necessarily reflect changes in adsorbed mucin on the ocular surface. I would point to the typographic error on page 1,286 in which the word "absorbed" is used in place of the correct "adsorbed."The hypothesis the authors advance that conjunctival goblet cell densities are an indicator of altered surface morphology is certainly consistent with their findings. The speculation that there might be premature corneal epithelial cell death, or accelerated exfoliation in a number of diseases is consistent with the data that we have
Lemp MA. Ocular Surface Disease. Arch Ophthalmol. 1984;102(2):194. doi:10.1001/archopht.1984.01040030148008
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