Giant Papillary Conjunctivitis

Dr Ben Wild

Overview

The eyelids are made up of various types of skin, muscle, glands, hair follicles and much more. Their purpose is to protect the eyes from dryness, bright lights and irritants.

Frontal view of a healthy eye with the upper lid flipped upwards.

Giant papillary conjunctivitis (GPC) occurs due to mechanical rubbing of foreign bodies on the inside of the upper lids. This rubbing causes a large allergic response where the inside of the upper eyelid develops large papillae (bumps containing immune response cells) and mucous secretions.

Frontal view of an eye with the top eyelid flipped upwards exposing GPC.

Most often, GPC occurs from accumulation of protein deposits on monthly disposable or biweekly disposable contact lenses that rub the eyelid each time a patient blinks. Alternatively, it can be caused by ocular prostheses (either cracked or poorly maintained), sutures after ocular surgery, scleral buckles after a retinal tear or detachment, filtering blebs after glaucoma surgery or even in cases of vernal keratoconjunctivitis or atopic keratoconjunctivitis (both types of allergic conjunctivitis).

Signs and Symptoms

Signs

Large papillae (bumps of immune cells) on the inside of the upper eyelids, mucous discharge.

Symptoms

Ocular irritation, contact lens intolerance, foreign body sensation, itchiness.

Causes and Risk Factors

Foreign bodies (protein on biweekly or monthly disposable contacts, rigid contact lenses, stitches, prosthetics, scleral buckles, blebs, etc.), severe allergies.

Prevention and Treatment

Prevention

Start with daily disposable contacts, avoid wearing contact lenses overnight, avoid wear contact lenses over 14 hours a day (different number for everyone), daily cleaning of ocular prosthetics.

Treatments

· Mast cell stabilizer drops.

· Antihistamine drops.

· Dual action antihistamine/mast cell drops.

· Steroid drops.

· Non-steroidal anti-inflammatory drops.

· Discontinue contact lens wear for several weeks.

· Decrease contact lens wear time.

· Change contact lens storage solution.

· Switch to daily disposable contacts.

· Laser eye surgery to avoid contact lens wear.

· Removal of scleral buckle.

· Removal of exposed sutures.

Prognosis

GPC is not a vision threatening condition but it can cause substantial ocular discomfort and contact lens intolerance (contact lenses become too uncomfortable to wear). It is also very difficult to treat and sometimes, although rarely, result in permanent contact lens intolerance. To avoid this fate, the treatments above should be started as soon as symptoms develop.