Changes in the tarsal conjunctiva viewed by in vivo confocal microscopy are associated with ocular symptoms and contact lens wear

Abstract

Purpose To investigate the effect of soft contact lens (CL) wear on the morphology of the epithelial‐lamina propria junction as well as the possible association with symptoms of discomfort. Methods Ninety‐two subjects were recruited, including 60 soft CL wearers, 16 previous wearers, and 16 non‐wearers. Additionally, subjects were classified as symptomatic or asymptomatic using the Contact Lens Dry Eye Questionnaire 8 for the CL wearers (a score ≥ 12 was considered symptomatic) and the Dry Eye Questionnaire 5 for the previous wearers and non‐wearers (a score ≥ 5 was considered symptomatic). In vivo confocal microscopy of the tarsal conjunctiva was performed on a single occasion. Papillae density, shortest diameter, longest diameter, area, circularity, lumen/wall brightness ratio, irregularity, reflectivity, inhomogeneous appearance of wall and inhomogeneous appearance of rete ridges were evaluated. Effects of CL wear, symptoms and their interaction were analysed using two‐way analysis of variance. Correlations were investigated using Spearman's coefficient. Data are presented as mean (standard deviation) or median [interquartile range]. Results Contact lens wearers, compared to previous wearers and non‐wearers, showed higher circularity [0.65 (0.08) vs 0.59 (0.10) vs 0.57 (0.11), p = 0.003]. Subjects with symptoms, compared to asymptomatic participants, showed higher circularity [0.64 (0.08) vs 0.61 (0.10), p < 0.001] and lower irregularity (1.0 [0.7–2.0] vs 1.3 [1.0–2.3], p = 0.009). For previous wearers, those with symptoms showed greater density (135.4 [107.3–183.3] vs 87.5 [85.4–116.7], p = 0.013) and circularity [0.64 (0.07) vs 0.54 (0.10), p = 0.016]. For non‐wearers, those with symptoms showed higher circularity [0.65 (0.08) vs 0.50 (0.08), p < 0.001]. DEQ‐5 correlated with circularity (ρ = 0.55, p = 0.001). Conclusions Soft CL wear modifies papillae of the epithelial‐lamina propria junction into a more rounded shape; however, CL cessation appears to resolve this alteration. Additionally, a more rounded papillae shape is associated with ocular symptoms in subjects not actively wearing CLs.

BCLA CLEAR - Contact lens complications

“…Although increased microvascular density in the lid wiper region was associated with a reduction in comfort in neophytes fitted with a SiHy contact lens after 6 h of wear [425], generalised lid margin vascularity was not associated with comfort in experienced contact lens wearers [362]. In symptomatic wearers, tarsal conjunctival papillae are more circular and more regular when imaged using IVCM compared to asymptomatics [426]. The presence of Demodex mites on the eyelid margins has been associated with symptomatic wear [388], and in individuals who had abandoned contact lens wear due to discomfort [427].…”

“…Retes ridges are invaginations of the epidermis into the underlying dermis between papillae at the dermal-epidermal junction. While changes in these structures have been associated with both contact lens wear and ocular symptoms [320,361,364], the interpretation of any IVCM data related to meibomian glands should be treated with caution, given the likely potential for confusion of meibomian glands with rete ridges, in addition to the limtation of the IVCM's 670 nm laser to penetrate to the depth of the meibomian glands themselves [365]. Two studies [320,361] also explored the reflectivity of the "meibomian gland secretions" using IVCM, reporting that contact lens wearers had significantly increased gland secretion reflectivity compared to non-lens wearers.…”

BCLA CLEAR - Evidence-based contact lens practice

“…The authors recommend to first evert the upper and lower eyelid to examine the hyperemia at the slit lamp with white light before instilling fluorescein [158]; however pragmatically, as multiple eversion of the lid can induce staining [159,160] if fluorescein is instilled before lid eversion, the ECP can assess redness with white light and switch to blue light and insert a yellow filter to observe roughness. More advanced clinical techniques, such as confocal microscopy [161][162][163] and OCT [164], have also been used to examine the palpebral conjunctiva, but are not routinely employed in clinical practice.…”