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Perilimbal Bulbar Conjunctival Pigmentation in Vernal Conjunctivitis: Prospective Evaluation of a New Clinical Sign in an Indian Population

Rao, Srinivas K DO, DNB, FRCSEd; Meenakshi, Swaminathan MS, AB; Srinivasan, Bhaskar MS; Baluswamy, Sukumar MPhil

Clinical Sciences

Objectives: 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 (21M, 4F) and controls (18M, 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.

From the Medical & Vision Research Foundations, 18, College Road, Chennai 600 006, Tamil Nadu, India.

Received for publication July 8, 2003; revision received November 19, 2003; accepted November 21, 2003.

The authors have no financial or proprietary interest in any of the materials used in this study.

Reprints: Dr Srinivas K Rao, Senior Consultant, Cornea Service, Sankara Nethralaya, 18, College Road, Chennai 600006, TN, India (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.