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—We appreciate the interest of Drs Butrus and Abelson. The five patients we described, who underwent excision of the upper palpebral conjunctiva and placement of a mucous membrane graft, experienced dramatic symptomatic improvement. Similar improvement was noted in the British and French series to which we referred. We are not so naive as to believe that our success with this group of patients is based solely on the decrease in the corneal irritation caused by giant papillae. The chemical mediators isolated in vernal conjunctivitis, however, do not detract from the mechanical aspects of the huge papillae rubbing the corneal epithelium. There is no reason that these causes must be exclusive. We believe that a major factor in the success of this procedure is, as we previously suggested, that "the transplated mucous membrane is apparently unable to respond to the stimuli, causing vernal conjunctivitis in the same fashion as
Tse DT, Baerveldt G, Mandelbaum S. Mucous Membrane Grafting for Severe Palpebral Vernal Conjunctivitis-Reply. Arch Ophthalmol. 1984;102(12):1748. doi:10.1001/archopht.1984.01040031412005