Abnormality of the conjunctival epithelium was evaluated in ten patients with severe thermal and chemical injuries at the scarred stage, eight patients with Stevens-Johnson syndrome, five with cicatricial ocular pemphigoid, and 13 normal subjects, based on goblet cell densities obtained using impression cytologic examination. The average and SDs of goblet cell densities were 197.4 +/- 264.4/mm2 in thermal and chemical injuries, 3.0 +/- 5.6/mm2 in Stevens-Johnson syndrome, 0.6 +/- 0.8/mm2 in cicatricial ocular pemphigoid, and 38.7 +/- 25.8/mm2 in normal subjects. There were statistically significant differences in goblet cell densities between thermal and chemical injuries and both Stevens-Johnson syndrome and cicatricial ocular pemphigoid. Moreover, conjunctival specimens from both eyes in six unilateral cases of thermal and chemical injuries revealed higher goblet cell densities in the injured than in the normal fellow eyes in all cases. These findings imply that ocular surface diseases with similar clinical manifestations may have different cell-biologic abnormalities in the conjunctival epithelium.