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Optometry Infographic: Papillae vs. Follicles

Posted by Amanda Dexter on December 17, 2016 at 11:49 AM
Amanda Dexter
Dr. Amanda K. Dexter received her optometric training at Southern California College of Optometry in Fullerton, California, where she was Class of 2010 Valedictorian. She also completed a residency in Primary Care and Ocular Disease at the Veteran's Affairs Hospital in San Diego, California. Dr. Dexter is the Manager and Program Coordinator for OptoPrep, the premiere online study resource for the NBEO Part I & II.


Most cases of conjunctivitis may be categorized as either papillary or follicular, according to the macroscopic and microscopic appearance of the conjunctiva.

-Papillary conjunctivitis shows a cobblestone arrangement of flattened nodules with central vascular cores. It is most commonly associated with an allergic immune response, as in vernal and atopic keratoconjunctivitis, or it is a response to a foreign body such as a contact lens or ocular prosthesis. The histologic appearance of papillary conjunctivitis is identical, regardless of the cause: closely packed, flat-topped projections, with numerous eosinophils, lymphocytes, plasma cells, and mast cells in the stroma surrounding a central vascular channel.

-Follicular conjunctivitis is seen in a variety of conditions, including inflammation caused by pathogens such as viruses, atypical bacteria, and toxins (including topical medications). In contrast to papillae, follicles are small, dome-shaped nodules without a prominent central vessel. Histologically, a lymphoid follicle is situated in the subepithelial region and consists of a germinal center, containing immature, proliferating lymphocytes; and surrounding corona, containing mature lymphocytes and plasma cells. A follicle appears more pale on its surface and more red at its base (in contrast to papillae which are more red at the surface and pale at the base). 

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