Introduction: An autoimmune condition called alopecia areata (AA) has been linked to ocular complications. There is not enough information on changes in conjunctival cytology in AA. Objectives: to evaluate the value of conjunctival impression cytology (CIC) in diagnosing ocular surface changes in AA patients and link the results with the disease severity. Patients and Methods: This case-control research was conducted on 50 participants who were divided into 2 groups: Group 1: included 25 patients with AA; group 2: included 25 age- and sexmatched healthy controls. For assessment of the ocular surface, both groups were subjected to the routine ophthalmological assessment, fluorescein tear breakup time [TBUT], Schirmer test, and CIC. Results: The patient group showed CIC grades 0, 1, 2, and 3 in 20.0%,40.0%,24.0%, and 16.0% of patients, respectively. In the control subjects, CIC results showed that all subjects showed grades 0, and 1 in 76.0% and 24.0%, respectively and none of them reported grades 2 and 3. A highly statistically significant difference was found between both groups regarding CIC results with a P-value < 0.000. A statistically significant relation was found between CIC results and SALT score. As regards the results of the TBUT and Schirmer tests, the patient group showed a statistically significantly lower mean score for both tests compared to the control group. Conclusion: Examining the ocular surface using impression cytology is a non-invasive procedure. Cell morphology can be utilized to recognize and rate the seriousness of conjunctival changes in patients with AA. Studying the possible underlying mechanisms is required further.

Conjunctival Impression Cytology; Dry eye; Tear Breakup Time test; Schirmer test; alopecia areata