Jalaiah Varikooty, MSc, BMed is a Clinical Scientist at the Centre for Contact Lens Research. Ulli Stahl, PhD, Dipl. Ing. (AO) is a Post-Doctoral Fellow at the Centre for Contact Lens Research.
Folliculosis is a type of a chronic follicular conjunctivitis that may have an allergic or toxic etiology or could be an acute condition associated with soft contact lens wear. Folliculosis and phlyctenulosis have a similar appearance. The following two videos demonstrate the difference in visualizing the appearance of limbal/conjunctival follicles by using white light with lissamine green stain and cobalt blue light with a yellow barrier filter in conjunction with sodium fluorescein dye.
The first video, using diffuse white light and scanning across the inferior limbal/conjunctival region, shows roughened grain-like elevations that are approximately 0.5–2.0 mm in diameter. The surrounding region is not hyperemic (as is seen with phlyctenulosis). Conjunctival staining, induced by the lens edge, is exhibited with lissamine green dye. Because diffuse white light has been used, it is impossible to visualize the limbal infiltrates underlying the follicles.
The second video shows the same limbal/conjunctival region using greater magnification. In this case sodium fluorescein dye clearly demonstrates staining of the follicles but does not highlight the elevations because the illumination technique used to capture this video image does not show a specular reflection of the follicles. The ring of conjunctival staining from the lens edge is also clearly visible with fluorescein dye.
These videos highlight the value of white light, lissamine green and sodium fluorescein during the process of biomicroscopic slit lamp examination.