Conjunctival Histopathological Changes Result From Vitamin D Deficiency in Children

Vitamins with spilled content
Vitamins with spilled content
Tear breakup time and Schirmer test measurements were significantly different between children with vitamin D deficiency and control group participants.

Vitamin D (Vit-D) deficiency affects tear functioning and results in significant conjunctival histopathological changes in children, according to a study published in Eye & Contact Lens

Researchers compared clinical parameters between children with Vit-D deficiency (group 1, n=38, mean age 13.25±2.05 years, 22 girls) and age-matched control individuals (group 2, n=45, mean age 13.13±2.36 years, 25 girls) including Schirmer test, tear breakup time (TBUT), and conjunctival impression cytology (CIC) in the prospective, case-control analysis. They administered the ocular surface disease index (OSDI) to assess dry eye symptomatology.

After comparing clinical parameters between groups 1 and 2, the team noted significant differences in TBUT (10 vs 11 s; P =.004) and Schirmer test results (12 vs 15 mm; P =.013). Investigators reported lower OSDI scores in group 1 compared with group 2 (16 vs 17), but this value failed to achieve statistical significance (P =.092).

CIC analysis revealed grades of 0 in 25 group 1 participants and 40 group 2 participants. Researchers graded 11 samples in group 1 and 5 samples in group 2 as grade 1, and 2 samples in group 1 and 0 samples in group 2 as grade 2 (P =.027). They noted lower mean goblet cell counts and higher median neutrophil counts in group 1 participants compared with group 2 (P <.001 and P =.004, respectively).

“One of the most important aspects of this study was that the cytological changes of pediatric patients who had Vit-D deficiency were investigated by CIC,” according to the investigators, “which was suggested as a gold standard test for dry eye disease by some researchers, and the findings determined herein may provide important information regarding the pathogenetic effects that Vit-D deficiency has on tear function in the pediatric population.”

Study limitations include a small sample size, single center design, and uncertainty of Vit-D deficiency duration in participants.   


Aksoy Aydemir G, Ilhan C, Pehlıvanoglu B, Aydemir E, Kiziltoprak H, Bolu S. Conjunctival histopathological changes in children with vitamin D deficiency. Eye Contact Lens. 2022;48(7):289-294. doi:10.1097/ICL.0000000000000903