Perilimbal bulbar conjunctival pigmentation in vernal conjunctivitis: prospective evaluation of a new clinical sign in an Indian population.
OBJECTIVE
To prospectively evaluate the occurrence of perilimbal conjunctival pigmentation in patients with vernal conjunctivitis and normal controls; to document the location, extent, density, and color of such pigmentation; and to correlate these changes with disease severity.


METHODS
Prospective, noninterventional case-control study. Demographic data, disease symptoms and duration, clinical signs of disease severity and extent, and characteristics of the perilimbal pigmentation were recorded.


RESULTS
Twenty-five patients with vernal conjunctivitis and 30 controls were studied. The mean age of the patients (21 M, 4 F) and controls (18 M, 12 F) was 7.5 +/- 3.7 years and 10.3 +/- 3.1 years, respectively. Perilimbal pigmentation was seen in all patients with vernal conjunctivitis and in none of the controls. The palpebral conjunctival changes and patient symptoms correlated with the severity of the disease in patients with vernal conjunctivitis. However, the extent of perilimbal pigmentation did not correlate with the symptoms and signs of vernal conjunctivitis or the density of palisadal pigment.


CONCLUSIONS
Perilimbal bulbar conjunctival pigmentation appears to be a consistent finding in patients with vernal conjunctivitis that is both specific and sensitive. It is also present in eyes with inactive disease and hence is a useful clinical sign that aids diagnosis in patients with mild or quiescent disease. Further studies are required to establish the histopathologic correlation of this finding and its etiopathogenesis. It is also important to establish whether this finding occurs with the same frequency in eyes of whites, as this study was performed in a cohort of Asian patients who have greater limbal pigmentation and a higher incidence of limbal changes in vernal conjunctivitis.
Rao
Srinivas K
SK
Medical & Vision Research Foundations, 18, College Road, Chennai 600 006, Tamil Nadu, India. drskr@sankaranethralaya.org
Meenakshi
Swaminathan
S
Srinivasan
Bhaskar
B
Baluswamy
Sukumar
S
D016022:Case-Control Studies; D002648:Child; D003229:Conjunctival Diseases / Q000175:diagnosis* / Q000208:ethnology; D003233:Conjunctivitis, Allergic / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010859:Pigmentation Disorders / Q000175:diagnosis* / Q000208:ethnology; D011446:Prospective Studies