الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
The genesis of histological changes accompanying the papillary
appearance in the conjunctiva in soft contact lens wearers was little
investigated.
Conjunctival impression cytology is a method used recently to
obtain a superficial conjunctival biopsy instead of exfoliative cytology
and excisional biopsy used previously.
The aim of. this work is to study different changes of the
conjunctiva in soft contact lens wearers including the papillary
appearance and correlate these changes to the cytological changes of
the conjunctiva.
368 eyes ( as study cases) and 124 eyes (as control cases) were
included in this study. The studiesd eyes were classified into 3 groups
according to the duration of contact lens wear. Each group was further
divided into 2 subgroups according to presence or absence of lens
intolerance symptoms. Eyes of the study groups were also categorized
into daily and extended use of contact lenses.
Slit-lamp Biomicroscopic examination of the upper tarsal
conjunctival surface with and without fluorescein, was done for both
study and control subjects . Conjunctival translucency, grade of
conjunctival Hypereamia and presence or absence of upper tarsal
conjunctival papillae ( satin, uniform, nonuniform or giant papillae)
were all listed.
Small strips of cellulose acetate filter paper with micropores of
0.45 micron were pressed against the upper palpebral and bulbar
Summary
(temporal and nasal) conjunctiva, then removed and preserved for
laboratory staining using a apecial staining protocol including periodic
acid schiff reagent and papanicolaou stain, then examined by light
microscope for squamous metaplasia.
In symptomatology itching was the highest symptom of
incidence in symptomatic subjects followed by mucus discharge and
lastly was lens intolerance.
Loss of conjunctival translucency was recorded markedly in
symptomatic subjects wearing extended contact lenses for a period
more than one year. The period of contact lens use had a significant
effect on conjunctival translucency, while the mode of their use had
not the same effect.
Grade + 3 conjunctival Hypereamia ( evere hypereamia ) was
not recorded in control subjects, slight in as mptomatic and marked
in symptomatic cases. The difference in c njunctival hypereamia
grades was insignificant between daily and extended wear lenses,
while there was marked shiffting of conjunctival hypereamia from
grade 0 to grade + 3 with increased the periOdjof contact lens use.
The apearance of macro or giant conjunctival papillae was
correlated to contact lenses use, as most eyes of the control group
showed uniform papillae with papillary diameter <0.3 mm and satin
appearance with no papillae, while giant papillae was not recorded in
any eye of the control group. No satin conjunctival appearance was
detected in the symptomatic cases which means that once the lens
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ISummary 1189 ~
wear become symptomatizing ,the conjUnctiv~ shows uniform or more
advanced papillary changed. On the other hand , giant papillary
appearance was recorded in small percentage in asymptomatic cases,
while it’s highest incidence was in the symptomatic cases wearing
extended lenses for a period of more than one year.
There was a marked significant shiffting of conjunctival
apearance from satin to uniform to nonuniform to giant papillary
appearance from asymptomatic to symptomatic subjects. Another
similar shift although less significant was detected with increased the
period of lenses use. This shift was lesser from daily wear to extended
contact lens wear but still had a significant value.
In specimens of impression cytology obtained, there was a
decrease in nuclear-cytoplasmic ratio of epithelial cells, meta
chromatic changes of cytoplasmic colour, emergence of keratinization
accompained by decrease in goblet cells and lor their impressions
(squamous metaplasia ).
In the control subjects , more than half of them had normal
conjunctiva with cytological grade 0 , and only one eye (out of 124
eyes) had squamous metaplasia grade 3.
In study subjects, the highest incidence of squamous metaplasia
grade 3 was detected in symptomatic subjects wearing extended lenses
for a period of more than one year, on the other hand grade 0, was not
detected in the symptomatic cases which means that, when symptoms
of contact lens. intolerance develop, the conjunctiva shows
Summary 190 I
pathological changes. The highest incidence of grade 0, ’vas in
asymptomatic subjects wearing daily used contact lenses for a period
less than 6 months.
There was a significant shift of conjunctival cytological c anges
from grade 0 to grade 3 in symptomatic cases rathe than
asymptomatic, and with the increase of period of lens use, wh Ie this
shift was slight in eyes with extended contact lenses to rath r than
eyes using the daily lenses.
There was a good correlation between the papillary appear nee of
conjunctiva and it’s cytological changes. All the satin appearar ce had
cytological grades 0 and 1 only. In uniform appearance the e was
marked shift of cytological changes from grade 0 to grade 3 . In
nonuniform appearance grade Owas not detected. The more advanced
stage of squamous metaplasia ( grade 3) was detected in ve y high
incidence in specimens from cases of giant papillae.
The pathological changes of conjunctiva were more advanced in . .
contact lens wearers ( study cases) than in control cases who ad the
same picture of papillary appearance.