Delayed tear clearance in contact lens associated papillary conjunctivitis

Purpose. To study the tear film clearance in contact lens associated papill ary conjunctivitis patients. Methods. Fifty-eight daily-wear soft contact lens wearers completed a quest ionnaire regarding a survey of their contact lens usage and subjective symp toms. They were grouped according to the size of conjunctival papillae, nam ely PC1 with no papillae, PC2 with papillae of less than 0.3 mm, and PC3 wi th papillae of 0.3-1.0 mm in diameter. Tear film breakup time and fluoresce in clearance tests were performed. Results. There was a median of 1, 2, and 3 subjective symptoms in PC1, PC2, and PC3 groups respectively (p < 0.001). Patients with larger papillae on their upper tarsus had more subjective symptoms such as burning sensation, discharge, limbal injection, foreign body sensation and dryness sensation ( p = 0.018, 0.001, 0.004, 0.005, and 0.036 respectively). They also had shor ter tear film breakup time (p = 0.05), delayed tear clearance (p = 0.002) a nd more corneal neovascularization (p < 0.001). Patients having delayed tea r clearance test tended to have more subjective symptoms (p = 0.004) and la rger papillae on upper tarsus (p = 0.002). However, neither the way the pat ients cleaned their contact lenses nor their enzyme cleaning frequency asso ciated with the tear fluorescein clearance (p = 0.528 and 0.394, respective ly). Meibomian gland dysfunction and corneal neovascularization did not cor relate with the delayed tear clearance either (p = 0.111 and 0.717, respect ively). Conclusions. Tear clearance in contact lens associated papillary conjunctiv itis patients was delayed. We proposed that delayed tear clearance might in crease the protein and inflammatory mediator concentrations in the tear fil m and contribute to the pathogenesis or aggravate the severity of contact l ens associated papillary conjunctivitis.