Giant papillary conjunctivitis is an allergy affecting the eye. It is characterized by a few small bumps under the eyelid of the affected person.
The underside of the eyelid is known as the upper tarsal conjunctiva.
When the upper tarsus rubs against something in the eye, these bumps develop. The term giant is associated with these bumps. GPC is also called contact lens-induced papillary conjunctivitis because it is most prevalent in people who use contact lenses.
Also Known As
- Giant papillary conjunctivitis (GPC)
- Contact lens-induced papillary conjunctivitis (CLPC)
- Primary GPC - There are two types of primary GPC; vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC)
- Secondary GPC
Causes and Risk Factors
The primary cause of giant papillary conjunctivitis is still unknown. The triggering event is believed to be an irritation of the upper lid perhaps by a contact lens surface followed by changes in the tissue. As a result, a person develops conjunctivitis. Any of the following may also cause GPC:
- When exposed sutures, a contact lens or an artificial eye rub against the eyelid
- Eye conditions such as ocular dermoids, corneal surface irregularity, glaucoma filtering blebs, extruded scleral buckles, ocular prosthesis and corneal scars
- Protein deposits or foreign substances on the contact lenses
- An allergy to chemicals used to clean contact lenses
- An allergy to contact lenses
- Contact wearers who have hay fever, asthma or any other allergies
Signs & Symptoms
Some of the common symptoms associated with GPC include:
- Burning sensation
- Foreign body sensation
- Contact lens movement
- Intolerance of contact lens
- Mucus secretion especially in the morning hours
- Blurred vision
- Bloody tears
- Drooping of the upper eyelid
The eye care professional will review the medical history of the patient and pay attention to their complaints. He/she may also observe the patient’s eyes and their contact lenses using a microscope. During this observation, the professional will flip the eyelid of the patient so that they may see the inner lining of the eyelid. They may also stain the surface of the eye with a yellow dye to help them make an accurate diagnosis.
GPC treatment is aimed at eliminating or reducing any mechanical stimulus from the contact lenses and strengthening the immune system response to antigens on the lens surface.
- Topical artificial tears - Artificial tears provide lubrication and help to wash away the environmental allergens and lens debris.
- Topical vasoconstrictor and antihistamine - These medications can provide relief. They include antazoline with xylometazoline.
- Topical mast cell stabilizers - These medications provide relief of dryness, mucus production, foreign body sensation and papillary size. They include lodoxamide, pemirolast, nedocromil and cromolyn sodium.
- Non-steroidal anti-inflammatory drugs (NSAIDs) - These drugs may improve symptoms. They can be combined with mast cell stabilizers. Some examples are ketorolac and diclofenac.
- Topical corticosteroids - They are used to treat resistant cases especially if it is difficult to remove the stimulus. Typical examples include fluorometholone and loteprednol.
The doctor may employ refractive surgery like laser-assisted in-situ keratomileusis (LASIK). This treatment is effective in:
- Suppressing ocular itching
- Returning contact lens tolerance
- Decreasing mucus in tears
- Decreasing inflammation of the giant papillae
- Decreasing hyperemia
The eye doctor will suggest a few simple home care procedures that will help their patient relieve mild GPC. These home treatment measures include:
- Using preservative-free cleaning solutions
- Cleaning lenses thoroughly each time they are taken out
- Rinsing and storing lenses in clean disinfecting solutions
- Sterilizing contact lenses with hydrogen peroxide
- Cleaning lenses with proteolytic enzyme once a year
If GPC is left untreated, the bumps may damage the cornea. This is because of the friction on the underside of the eyelid.
GPC can be treated and reversed. Patients ought to seek medical attention as soon as they notice the symptoms of this eye condition. Early treatment helps improve one’s chances of total recovery. Patients should be instructed on contact lens cleaning to avoid a relapse of the symptoms. Up to 80% of patients usually return to comfortable contact lens wear.
Some of the preventive measures you can use to lower the prevalence of GPC are:
- Decreased wear time
- Early professional supervision
- Rigorous cleaning measures
- Hydrogen peroxide disinfection
- Regular contact lens replacement