1. Authors: Jeewan S Titiyal, Saurbhi Khurana, Namrata Sharma, Tushar Agarwal, Bhavana Chawla, Radhika Tandon, T Velpandian R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India None of the authors have any financial interests

2.  Common cause  Discomfort,decreased wearing time  Discontinuation of contact lenses  Management  Anti-allergic treatment : topical vasoconstrictors,antihistamines,mast cell stabilizers, steroids,lubricants

3.  To compare the efficacy of olopatadine (0.1%) & fluorometholone (0.1%) in mild to moderate contact lens induced papillary conjunctivitis

4. 85 CL wearers (170 eyes) with mild to moderate papillary conjunctivitis enrolled and randomized into 3 treatment groups:  Group A : Fluorometholone 0.1% BD + placebo BD  Group B : Olopatadine HCL 0.1%BD + placebo BD  Group C : Fluorometholone 0.1% BD + Olopatadine HCL 0.1%BD Hydroxypropyl Methyl Cellulose 0.3% QID used in all groups as lubricant

5.  Demographic and CL parameters at baseline  Symptoms and signs of papillary conjunctivitis graded on 4 point scale (Redness, Itching & tearing, Congestion, Papillary reaction, CL tolerance after 4 weeks of treatment)  Tear function tests: (Schirmer and T-BUT)  IOP and any other adverse effects Follow up- 2 weekly for 8 weeks  CL discontinued for 4 weeks during treatment and monthly disposable lenses prescribed thereafter

6.  Redness: -Significant improvement in all 3 groups by 4 weeks (P=0.001) - persistent redness less with olopatadine as compared to fluorometholone at 8 weeks (P=0.01)  Itching and tearing : improved comparably in all groups by 4 weeks (P=0.001)

7.  CL tolerance : significant and comparable improvement in all groups. (P=0.017 Group A, P=0.001 Group B&C) Before treatment (% of eyes) After treatment (% of eyes) CL tolerance< 6hrs<3hrs<45 mins >6hrs3-6hrs<3hrs Group A26%9%-83%17%- Group B26%22%4%83%12%5% Group C29%14%3%94%6%-

8.  Congestion : improved significantly in all groups (P=0.001)  Papillary reaction : comparable improvement in all groups(P=0.001) At baseline (% of eyes)At 8 weeks (% of eyes) Papillary reaction Grade 1Grade 2Grade 3Grade 1 (asymptomati c) Group A76%22%2%48% Group B65%30%5%46% Group C52%36%12%44%

9. Group A (fluorometholone) Group B olopatadine Group C fluorometholone and oloapatadine

10.  Schirmer and T-BUT : - improvement over 8 weeks in eyes using fluorometholone. (P=0.04 Group C schirmer, P=0.001 in group A&C TBUT) - no overall change with olopatadine - in eyes with subnormal baseline tests, significant improvement in all 3 groups. (P<0.005 Schirmer and P<0.007 TBUT in all groups)

11.  IOP : -significant increase from baseline to 8 th week in eyes using fluorometholone. (P= 0.003 group A and P=0.039 group C) -no change with olopatadine.  No other adverse effect attributable to treatment.

12.  Olopatadine 0.1% is effective in alleviating the symptoms and signs of CL induced mild to moderate papillary conjunctivitis and is comparable to fluorometholone 0.1% in efficacy  Improvement of tear functions better with Fluorometholone than olopatadine  However, prolonged use of fluorometholone requires IOP monitoring