Conjunctival impression cytology was performed on 236 Indonesian preschool children, half of whom had mild xerophthalmia and half of whom were age-matched controls. We devised an applicator that applies a paper disk of fixed area to the conjunctiva with even pressure. The disk applicator was used to collect impression cytology specimens from the temporal bulbar conjunctiva of one eye while the original strip technique was used on the other eye. Mean (+/- SD) serum retinol values for children with normal and abnormal discs were 22.0 +/- 8.6 micrograms/dL and 18.0 +/- 7.2 micrograms/dL P less than .0001). Mean serum values for normal and abnormal strips were 21.7 +/- 8.6 micrograms/dL and 19.0 +/- 7.7 micrograms/dL (P less than .03). Specimens obtained with the new disk applicator corresponded more closely with serum vitamin A levels and therefore vitamin A status than those obtained with the traditional strip technique.

Vitamin A status was assessed by conjunctival impression cytology (CIC-A) and clinical signs in 60 systematically sampled 36–83 month old children attending a hospital outpatient department on Moen, Truk. Seventeen percent had xerophthalmia (12% with XN, 5% with XN+X1B). More than half (57%) were CIC-A abnormal reflecting mild subclinical vitamin A deficiency. CIC-A abnormal children were more anemic (by hematocrit, p<0.05) and were at greater risk of middle ear infection (OR=3.5, 95% CL: 0.8, 14.5). Vitamin A deficiency appears to be a previously unrecognized nutritional problem among Micronesian children, the causes for which are speculative at present.