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Vernal Keratoconjunctivitis With Giant Papillae on the Inferior Tarsal Conjunctiva

Asada, Yosuke MD; Ebihara, Nobuyuki MD, PhD; Funaki, Toshinari MD, PhD; Yokoi, Norihiko MD, PhD; Murakami, Akira MD, PhD; Matsuda, Akira MD, PhD

doi: 10.1097/ICO.0000000000000009
Clinical Science

Purpose: 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.

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*Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan; and

Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Reprints: Akira Matsuda, Laboratory of Ocular Atopic Diseases, Department of Ophthalmology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8431, Japan (e-mail:

Supported in part by Grants-in-aid from the Japan Society for the Promotion of Science (No. 24592652 to A.Ma., 24659768 to A.Mu.), the Takeda Science Foundation (A.Ma.), and the Institute for Environmental and Gender-specific Medicine, Juntendo University (A.Ma.).

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received April 08, 2013

Accepted September 16, 2013

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