Vernal keratoconjunctivitis with giant papillae on the inferior tarsal conjunctiva.
OBJECTIVE
In vernal keratoconjunctivitis (VKC), giant papillae are commonly observed on the superior tarsal conjunctiva. We found 3 cases of giant papillae on the inferior tarsal conjunctiva, and diagnosed them as being VKC based on their clinical and histopathological features.


METHODS
Three patients with inferior tarsal giant papillae were studied. In 2 patients, the giant papillae were resected for therapeutic purposes. Immunohistochemical analysis was carried out by indirect immunofluorescent staining using anti-CD3, anti-CD20, anti-CD35 antibodies.


RESULTS
In all 3 patients, giant papilla formation was observed on the inferior lid margin. Clusters of CD20 B lymphocytes with CD35 follicular dendritic cells, and CD3 marginal zone T lymphocytes, common features of lymphoid neogenesis, were observed. In 2 patients, typical giant papillary formation was also observed on the superior tarsal conjunctiva. In all the patients, topical dexamethasone and tacrolimus treatments were found to be effective.


CONCLUSIONS
The giant papillae of VKC can occur not only on the superior tarsal conjunctiva but also on the inferior tarsal conjunctiva. The possibility of the presence of giant papillae on the inferior tarsal conjunctiva should be considered in the clinical examination of patients with VKC.
*Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; and †Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Yosuke
Y
Asada
Nobuyuki
N
Ebihara
Toshinari
T
Funaki
Norihiko
N
Yokoi
Akira
A
Murakami
Akira
A
Matsuda
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology; D001402:B-Lymphocytes / Q000166:cytology / Q000276:immunology; D002648:Child; D003233:Conjunctivitis, Allergic / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male
D000893:Anti-Inflammatory Agents; D018951:Antigens, CD20; D007166:Immunosuppressive Agents