Delayed tear clearance in contact lens associated papillary conjunctivitis.
OBJECTIVE
To study the tear film clearance in contact lens associated papillary conjunctivitis patients.


METHODS
Fifty-eight daily-wear soft contact lens wearers completed a questionnaire regarding a survey of their contact lens usage and subjective symptoms. They were grouped according to the size of conjunctival papillae, namely PC1 with no papillae, PC2 with papillae of less than 0.3 mm, and PC3 with papillae of 0.3-1.0 mm in diameter. Tear film breakup time and fluorescein clearance tests were performed.


RESULTS
There was a median of 1, 2, and 3 subjective symptoms in PC1, PC2, and PC3 groups respectively (p < 0.001). Patients with larger papillae on their upper tarsus had more subjective symptoms such as burning sensation, discharge, limbal injection, foreign body sensation and dryness sensation (p = 0.018, 0.001, 0.004, 0.005, and 0.036 respectively). They also had shorter tear film breakup time (p = 0.05), delayed tear clearance (p = 0.002) and more corneal neovascularization (p < 0.001). Patients having delayed tear clearance test tended to have more subjective symptoms (p = 0.004) and larger papillae on upper tarsus (p = 0.002). However, neither the way the patients cleaned their contact lenses nor their enzyme cleaning frequency associated with the tear fluorescein clearance (p = 0.528 and 0.394, respectively). Meibomian gland dysfunction and corneal neovascularization did not correlate with the delayed tear clearance either (p = 0.111 and 0.717, respectively).


CONCLUSIONS
Tear clearance in contact lens associated papillary conjunctivitis patients was delayed. We proposed that delayed tear clearance might increase the protein and inflammatory mediator concentrations in the tear film and contribute to the pathogenesis or aggravate the severity of contact lens associated papillary conjunctivitis.
Chang
S W
SW
Department of Ophthalmology, Chang Gung University and Memorial Hospital, 5 Fu-Hsing St., Kwei-Shan Hsiang, Taoyuan, Taiwan 333. shuwenchang@cgmh.org.tw
Chang
C J
CJ
D000328:Adult; D003233:Conjunctivitis, Allergic / Q000209:etiology / Q000378:metabolism*; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects*; D016510:Corneal Neovascularization / Q000378:metabolism; D005141:Eyelid Diseases / Q000378:metabolism; D005260:Female; D019793:Fluorescein; D015590:Fluorophotometry; D006801:Humans; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism*
D019793:Fluorescein