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Y. Satake, Y. Takano, A. Igarashi, A. Kujira, N. Okada, M. Tanaka, K. Fukagawa, M. Dogru, J. Shimazaki, H. Fujishima; Pathological Evaluation of Tarsal Conjunctival Milky Spots in Atopic Keratoconjunctivitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2312.
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© ARVO (1962-2015); The Authors (2016-present)
The morphological appearance of conjunctiva, such as papillae or follicles, is helpful and critical in the correct diagnosis of conjunctival diseases. In severe ocular allergies sometimes pre-papillary lesions with a "milky spot" appearance is observed in the process of formation of tarsal giant papillae. We compared the histological features of milky spots with tarsal giant papillae and conjunctival follicles using immunohistochemical staining.
Tarsal giant papillae, milky spots, and follicles from patients with AKC or seasonal allergic conjunctivitis were harvested and analyzed immunohistologically and the types of infiltrating inflammatory cells (CD4+ T cells, eosinophils, mast cells, antigen presenting cells, and fibroblasts) and their distributions were evaluated in each tissue.
Mast cells and eosinophils were observed in milky spots as well as tarsal giant papillae, but not in follicles. Although the pattern of infiltration of CD4+ T cells was diffuse in tarsal giant papillae, in milky spots the pattern was similar to germinal centers of lymph nodes. Mature dendritic cells with positive staining for CD11c and CD208 were distributed in areas abundant with CD4+ T cells in all tissues. On the other hand, immature dendritic cells with positive staining for CD1a were observed in the stratified conjunctival epithelial layer in tarsal giant papillae and milky spots, but not in follicles. Fibroblasts were strongly and diffusely positive in tarsal giant papillae, but in milky spots only weak staining was observed.
Milky spots were inflammatory masses with little fibrosis with characteristics of both tarsal giant papillae and follicles.
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