Giant Papillary Conjunctivitis Clinical Presentation
- Author: Barry A Weissman, OD, PhD, FAAO; Chief Editor: Hampton Roy, Sr, MD more...
Patients with giant papillary conjunctivitis (GPC) often report an increase in contact lens soilage, ocular itching, and mucous discharge in tears, as well as blurred vision and conjunctival injection. This can be accompanied by decreased contact lens tolerance and mechanical stability.
Giant papillary conjunctivitis can follow a seasonality similar to that of environmental allergies. There is no association with giant papillary conjunctivitis development and ocular bacterial bioburden.
Clinicians commonly note increased deposition on contact lenses. Also, contact lenses appear to ride higher under the upper lids than expected. Rigid lenses in particular, show deposits around the lens edge.
With eversion of the lids, inflammation of the vasculature (hyperemia) and papillary hypertrophy are noted. (See the images below.)
Mucous strands can be seen in the tears and between the papillae.
Papillae can range from small, uniform lesions (uniform cobblestone appearance [UCA]) to irregular changes (nonuniform cobblestone appearance [NUCA]) to clusters of giant lesions with whitish centers that can ulcerate and stain with sodium fluorescein dye. Originally, the papillae of the upper tarsal conjunctiva were thought to have to be at least 1 mm to diagnose giant papillary conjunctivitis. Today, the clinical sign is generally accepted as follows: the papillae are at least 0.3 mm in diameter on the upper palpebral conjunctiva in association with the classic symptoms.
Giant papillary conjunctivitis that is associated with hydrogel contact lenses is more commonly at the fold of the everted lid, spreading over the entire tarsal conjunctival surface.
Giant papillary conjunctivitis that is associated with rigid contact lens wear shows an opposite pattern, corresponding to the position of the contact lens edge meeting the lid tissues. This is evidence for the mechanical etiology hypothesis.
Silicone hydrogel lenses tend to induce more local than general giant papillary conjunctivitis responses, similar to that seen with rigid lens wear.
Attending eye doctors should routinely invert and visually inspect lids, especially if a patient who wears contact lenses has any ocular complaints.
Subjective ocular itching, mucus, contact lenses with significant protein deposits, and contact lenses that become less comfortable, more mobile, or ride higher underneath the upper lids should all raise suspicion of giant papillary conjunctivitis.
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