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Ocular papillary changes on the caruncle surface in allergic conjunctivitis
Poster Title: Ocular papillary changes on the caruncle surface in allergic conjunctivitis
Submitted on 21 Feb 2015
Author(s): Milton M. Hom, OD, FAAO1, Leslie E. O’Dell, OD, FAAO2, Carl J. May, Jr., MD2, Leonard Bielory, MD3
Affiliations: 1Private Practice, Azusa, CA 2The May Eye Care Center and Associates, Hanover, PA. 3Rutgers University, New Brunswick, NJ.
This poster was presented at AAAAI 2015
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Poster Information
Abstract: 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.
Summary: The caruncle is small, pink, globular nodule at the inner corner of the eye. We found the papillary changes of the caruncle corresponds to changes in palpebral conjunctiva seen in allergic conjunctivitis. There may indicate a greater inflammatory response in the caruncle resulting in greater itching in the nasal corners of the eye. Allergists can easily assess the caruncle.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:
Leonard Bielory, M.D.,
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