Aim: To examine conjunctival papilloma and normal conjunctival tissue for the presence of human papillomavirus (HPV). Methods: Archival paraffin wax-embedded tissue from 165 conjunctival papillomas and from 20 histological normal conjunctival biopsy specimens was analysed for the presence of HPV by PCR. Specimens considered HPV positive using consensus primers, but with a negative or uncertain PCR result using typespecific HPV probes, were analysed with DNA sequencing. Results: HPV was present in 86 of 106 (81%) b-globin-positive papillomas. HPV type 6 was positive in 80 cases, HPV type 11 was identified in 5 cases and HPV type 45 was present in a single papilloma. All the 20 normal conjunctival biopsy specimens were b-globin positive and HPV negative. Conclusion: There is a strong association between HPV and conjunctival papilloma. The study presents the largest material of conjunctival papilloma investigated for HPV and the first investigation of HPV in normal conjunctival tissue. HPV types 6 and 11 are the most common HPV types in conjunctival papilloma. This also is the first report of HPV type 45 in conjunctival papilloma.H uman papillomavirus (HPV) is associated with the occurrence of conjunctival papilloma. 1 The individual HPV types are trophic for cutaneous or mucosal epithelium and have different oncogenic potentials. 2 So far, low-risk HPV types 6 and 11 and high-risk HPV types 16 and 33 have been identified in conjunctival papilloma. 1 3-6 To our knowledge, similar studies on normal conjunctiva have not been reported to date. Therefore, it is still unclear whether HPV plays a crucial role in the development of conjunctival papilloma.The purpose of this study was to analyse the largest material of conjunctival papilloma to date (fig 1) and normal conjunctival tissue for the presence of various HPV types. The aim was also to investigate for HPV types not described previously in conjunctival papilloma, and to determine whether HPV is a common pathogen on the normal ocular surface.
MATERIALS AND METHODSWe studied 165 cases of conjunctival papilloma from the files of the Eye Pathology Institute, Copenhagen, Denmark. The formalin-fixed, paraffin wax-embedded specimens were registered during the period 1988-97. A histological review of the diagnosis was made in each case. The material did not include our previous series of 55 conjunctival papillomas. 1