Jalaiah Varikooty is a clinical researcher at the Centre for Contact Lens Research, School of Optometry and Vision Science, University of Waterloo, Canada.

The following slit-lamp videos and images collected at the Centre for Contact Lens Research highlight the clinical appearance of a series of contact lens-related conjunctival findings: lid wiper epitheliopathy, conjunctival flaps, lid-parallel conjunctival folds and conjunctival indentation.

Lid wiper epitheliopathy

In the following video, lissamine green dye highlights lid wiper epitheliopathy (LWE), which extends horizontally from the medial (right side of video frame) to the lateral canthus, and from the Marx line (sharp green border of superior staining) up to the tarsal sulcus fold. In some places, the stain extends onto the tarsus beyond the sulcus fold. Slit-lamp image obtained at 8X magnification.

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Conjunctival flaps

Conjunctival flaps, areas of loose conjunctival tissue often located along an area of indentation, is best viewed with sodium fluorescein + cobalt blue filter + yellow wratten filter #12. The conjunctival region inner to the flap (towards limbus) may be irregular while the region outside the indentation is smooth. Conjunctival flaps resolve spontaneously with discontinuation of lens wear. Slit-lamp image obtained at 12X magnification.

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Lid-parallel conjunctival folds

Lid-parallel conjunctival folds (LIPCOF) are sub-clinical folds present at the temporal regions of the inferior bulbar conjunctiva and parallel to the lid margin. Three clear folds can be seen in the following image: an inferior fold closer to the lid margin, a superior fold that seems to be causing a ‘kink’ in the conjunctival vessel at the medial end, and a fold just below the superior fold laterally. Slit-lamp image obtained at 32X magnification.

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Conjunctival indentation

The following image shows conjunctival indentation in the superior region of the bulbar conjunctiva as an arc of sodium fluorescein stain. Through a slit-lamp, the outer border of the indentation may be seen as a slightly raised ridge of conjunctival tissue, and is usually best viewed with sodium fluorescein + cobalt blue filter + Yellow wratten filter #12 at mid-magnification (12X or 20X). Conjunctival indentation usually corresponds to the circumference of the contact lens region. Slit-lamp image obtained at 12X magnification.

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