Conjunctival synthetic fiber granuloma. A lesion that resembles conjunctivitis nodosa.

Histopathologic examination of forniceal conjunctival lesions excised from five young patients revealed granulomatous inflammation surrounding filamentous foreign material. Polarization microscopy, special histochemical stains, scanning electron microscopy and energy dispersive x-ray elemental analysis identified the inciting material as predominantly synthetic fabric fiber. Three of these cases initially were diagnosed as conjunctivitis nodosa, an inflammatory reaction to caterpillar setae. Many synthetic fibers contained numerous granules of titanium, barium, or zinc delustering agent, which served to differentiate them from natural fibers or caterpillar hairs. Synthetic fabric fiber is a previously unrecognized cause of conjunctival inflammatory mass lesions.