Cellulose acetate impressions of the ocular surface were obtained for normal eyes, eyes with blepharoconjunctivitis, eyes with keratoconjunctivitis sicca, and eyes with primary ocular surface disease. Normal eyes and eyes with blepharoconjunctivitis had morphologically normal epithelium and goblet cells on the bulbar and palpebral ocular surfaces. Eyes with primary ocular surface disease had abnormal ocular surface impressions (decreased, abnormal, or absent goblet cells with abnormal epithelial cells) on both the bulbar and palpebral ocular surfaces. Conversely, eyes with keratoconjunctivitis sicca had substantial abnormalities of the epithelium and goblet cells only on the bulbar ocular surface, suggesting an environmental role in this disease process.