Vernal keratoconjunctivitis with giant papillae on the inferior tarsal conjunctiva

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.

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.

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.

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.