Mascara pigmentation of the bulbar conjunctiva associated with rigid gas permeable lens wear

We present three patients who were found to have unusual pigmentation of the bulbar conjunctiva. The areas, 1 to 2 mm in size, were translucent with dark black dust-like particles randomly placed within well defined borders. These specks were usually elevated, had a granular texture, and appeared to be overlying pingueculae. All three patients wore rigid gas permeable contact lenses, were found to have either a short tear break-up time or deficient tear aqueous layer, had associated 3:00 and 9:00 o'clock staining, and routinely used heavy mascara and/or eyeliner. In one patient, the areas resolved on discontinuing contact lens wear. The elevated areas may be associated with minor discomfort. We propose that a deficient tear layer and drying adjacent to the lens edge may compromise the conjunctival epithelium and prevent efficient washing of the pigment particles from the conjunctiva, allowing these granules to become embedded in the epithelium. Additional causes of conjunctival pigmentation are discussed.