Antonio S. Henriquez

Giant Papillary Conjunctivitis in Contact Lens Wearers

A syndrome that occurred in both hard and soft contact lens wearers was characterized by increased mucus, itching, decreased lens tolerance, and giant papillae in the upper tarsal conjunctiva. It developed in as few as three weeks with soft lens wearers but also occurred after months or even years of successful wear. The histology was characterized by basophils, eosinophils, and mast cells in the epithelium, and these cells as well as increased numbers of lymphocytes, plasma cells, and polymorphonuclear leukocytes in the stroma. The syndrome may be immunologic in origin with deposits on the lenses as the antigen, and the syndrome may be a major cause of difficulty in wearing contact lenses once they have been successfully fit.

Morphologic characteristics of posterior polymorphous dystrophy. A study of nine corneas and review of the literature.

Based on their own study of nine corneas with clinically documented posterior polymorphous dystrophy and a review of the literature, the authors describe the morphologic features of this entity. Study by phase contrast light microscopy and transmission and scanning electron microscopy found that changes were primarily in the endothelium and consisted of endothelial cell degeneration and loss with focal fibroblastic and epithelial-like cell transformation. Secondary alterations of Descemets membrane were seen; they consisted of abnormal lamination with deposition of abnormal collagen material, particularly in the posterior collagen layer, and formation of guttate excrescences and pits.

Prevalence of Conjunctival Changes in Wearers of Hard Contact Lenses

The prevalence of elevated papillae more than 0.3 mm in diameter was 10.5% in the conjunctivae of 200 subjects who had successfully worn polymethylmethacrylate hard contact lenses for eight hours or more daily for more than five years. Only three of 500 (0.6%) control subjects who had never worn contact lenses had these papillary changes. The prevalence of papillary changes for those with the so-called normal symptoms of mucus, itching, or both associated with wearing of hard contact lenses was 53% (16 of 21 subjects). The prevalence of these symptoms was 76% among subjects with polymethylmethacrylate contact lenses who had papillary changes and 8% among subjects with polymethylmethacrylate contact lenses who did not have papillary changes. We conclude that changes in the upper tarsal conjunctiva are associated with the wearing of hard contact lenses, occur in a significant percentage of patients wearing hard contact lenses for prolonged periods, and include a spectrum of papillary changes.

Biomicroscopy of papillae associated with hard contact lens wearing.

We studied the macrostructural characteristics of papillary changes of the upper tarsal conjunctiva associated with the wearing of polymethyl methacrylate (PMMA) contact lenses. Fifty subjects with elevated conjunctival papillae greater than 0.3 mm in diameter were studied. Macrostructural characteristics recorded were location, diameter, and number of papillae, presence or absence of staining at the apices of papillae, and degree of hyperemia of the upper tarsal conjunctiva. Patient information collected included age, duration of lens wear, average daily lens wearing time, presence or absence of itching or mucus, refractive status, and atopic history. The tarsal conjunctiva was divided into three zones of equal size. Papillae were present in various zones and combinations of zones; however, papillae were never confined exclusively to either (1) the zone adjacent to the tarsal folds or (2) the latter zone in combination with the zone adjacent to the eyelid margin without also occurring in the intervening zone. The diameter of the papillae ranged from greater than 0.3 mm to 2.0 mm. The number of papillae per eyelid ranged from two to over 100. The apices of the papillae were frequently flattened and craterlike, and often stained with fluorescein.

Surface Ultrastructure in Alkali-Burned Rabbit Corneas

The scanning electron microscope was used to follow morphologic events after alkali burn of rabbit corneas. Immediately after a burn there was extensive destruction and shrinkage of the epithelial cells. In subsequent healing, the regenerated superficial cells were morphologically abnormal and possed multiloculated cysts; three months later the normal polygonal packing of cells was not observed. Although the shape of these cells was irregular, microprojections were present on the cell surface. Basal cells were usually observed at the edge of an epithelial defect, an area where the epithelium was easily detached from the basement membrane. In long-standing epithelial defects, the basement membrane became eroded in a spot-like manner after about two weeks. Eventually, when a frank stromal ulcer had formed, bundles of collagen fibrils were visible in a meshwork-like fashion. These changes did not seem to be caused by the direct action of alkali but rather by latent secondary factors that took days or weeks to activate.

Histopathology of human keratorefractive lenticules.

Eight human corneal lenticules (three from keratophakia, two from hypermetropic keratomileusis, and three from myopic keratomileusis) were examined by light and electron microscopy. The keratophakic lenticules were removed for optical reasons 3, 3.5, and 6 months after surgery. Microscopically, all displayed hypocellularity, mature collagen fibrils and microfibrils, keratocyte ghosts, and keratocytic debris. The hypermetropic keratomileusis specimens were removed at 13 and 14 months postoperatively, the first because of opacities from enzymatic digestion of the cornea, and the second due to contact lens-induced erosion of Bowmans layer and decreased lacrimal secretion. Ultrastructurally, both lenticules exhibited fractures in Bowmans layer, and the 14-month specimen showed multilayered squamous epithelia. The myopic keratomileusis specimens were removed at 4, 8, and 48 months postoperatively due to opacification of the interface caused by delayed epithelial healing, detergent trauma, and previous epithelization, respectively. Electron microscopy revealed fractures in Bowmans layer, subepithelial fibrocellular growth, sparse keratocyte populations of the anterior stroma, porous collagen bundles, keratocytic debris, and regions of epithelial ingrowth.