Download Results Methods (con`t)

AAAAI 2015, Houston, TX
#885
Ocular papillary changes on the caruncle surface in allergic conjunctivitis
Milton M. Hom, OD,
1
Rationale: The caruncle is located in the nasal corner of the eye and can be easily viewed.
Prior reports have associated papillary changes on the caruncle surface as diagnostic sign of
allergic conjunctivitis. We examined the caruncle and the rest of the palpebral conjunctiva
under magnification and fluorescein dye to determine surface roughness in this multi-site,
non-interventional, retrospective chart review.
Methods: Subjects over age 18 were viewed with a slit lamp and fluorescein dye under cobalt
blue light with a yellow filter as part of routine eye examination. The caruncle was graded in
0.5 steps (0 smooth/normal to 4 severe papillary response). The palpebral conjunctiva was
also examined and graded in the same manner. Results: 285 consecutive patients were seen in two clinics. Significant differences were found
between the caruncle and palpebral surfaces scores (p<.0000). The caruncle scores were
consistently higher (mean 1.76 SD 0.82) than palpebral conjunctiva scores (mean 1.34 SD
0.74). Pearson correlation was 0.3 (p<.0000)
Conclusions: Greater papillae in the caruncle may indicate a greater inflammatory response
when compared to the palpebral conjunctiva. This may explain why eye rubbing with allergic
conjunctivitis is more likely to occur in the corner of the eyes where the caruncle is located.
Allergists can examine the caruncle with the naked eye. Along with the location of eye
rubbing, this can help to diagnose allergic conjunctivitis.
Caruncle is small, pink, globular nodule at the inner corner (the medial
angle) of the eye (see Figure 1)
Other terms: Caruncula lacrimalis or lacrimal caruncle
May be inflamed and pruritic (itchy) in allergic conjunctivitis
“Caruncular nodularity” previously described as sign of SAC1
Leslie E. O’Dell, OD,
Private Practice, Azusa, CA
Abstract
Introduction
1
FAAO ,
2 The
2
FAAO ,
Carl J. May, Jr.,
May Eye Care Center and Associates, Hanover, PA.
3
2
MD ,
Leonard Bielory,
Rutgers University, New Brunswick, NJ.
Results (con’t)
Methods (con’t)
Figure 1: Location of the caruncle
Figure 3: Surface roughness viewed with white light and fluorescein dye for papillary conjunctivitis
White light
Figure 6: Mild correlation
Pearson 0.30 between
caruncle and papillary
changes.
Fluorescein dye
Methods
Discussion & Conclusion
•  Subjects over age 18
•  Non-interventional, retrospective chart review
•  Palpebral conjunctiva and caruncle under magnification
with biomicroscope (See Figures 2 and 3)
•  Papillary changes in the lids are the hallmark of allergic conjunctivitis signs
Results
•  Can also occur in caruncle (mild correlation)
•  Caruncle surface changes are more severe than lid surface changes.
•  Fluorescein dye under cobalt blue light with a yellow filter
•  Determine surface roughness: caruncle and papillary
conjunctivitis
•  Graded in 0.5 steps (0 smooth/normal to 4 severe papillary
response). Figure 2: Caruncle surface roughness viewed with white light and fluorescein dye. Papillary changes are more
visible with fluorescein dye. White light
•  285 consecutive patients were seen in two clinics. •  May be due to greater inflammatory response in caruncle than rest of the eye
•  Caruncle scores were consistently higher (mean 1.76 SD 0.82) than
palpebral conjunctiva scores (mean 1.34 SD 0.74). •  May explain why allergic eye rubbing more likely to occur in the corner of the
eyes (caruncle area)
•  Allergists can examine the caruncle for surface roughness (papillary changes)
with the naked eye
•  Significant differences were found between the caruncle and
palpebral surfaces scores (p<.0001). (See Figure 5) •  Pearson correlation was 0.3 (p<.0001) (See Figure 6)
•  Along with the location of eye rubbing, this can help to diagnose allergic
conjunctivitis.
Fluorescein dye
Within eyecare, described as papillary formation or surface roughness
seen in palpebral conjunctiva.2
3
MD
Figure 5
Higher severity seen with caruncle
when compared to papillary changes in
the lid (p<.0001). 1
References
1.Nsouli TM. Schluckebier CD. Nsouli ST, Diliberto NZ. Bellanti JA. Caruncular nodularity: new sign for seasonal
allergic conjunctivitis. Annal Allergy Asthma and Immunology. 2013; 111(5):A110. Program #P307.
2. Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM. Giant papillary conjunctivitis
in contact lens wearers. Am J Ophthalmol 1977;83:697-708.
Author’s contact information:
Milton M. Hom, OD, FAAO: [email protected]
Leonard Bielory, M.D., [email protected]
,