eMedicine Specialties > Ophthalmology > Conjunctiva

Conjunctivitis, Giant Papillary: Differential Diagnoses & Workup

Author: Barry A Weissman, OD, PhD, FAAO, Chief of Contact Lens Service, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles
Coauthor(s): Karen K Yeung, OD, FAAO, Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California at Los Angeles
Contributor Information and Disclosures

Updated: Nov 2, 2007

Differential Diagnoses

Chlamydia
Conjunctivitis, Allergic
Conjunctivitis, Bacterial
Conjunctivitis, Viral
Ptosis, Congenital

Workup

Laboratory Studies

  • No lab studies are necessary, although some authors advocate screening patients who wear CLs for increased levels of IgE in their tears.
  • Because of the high prevalence of this complication to CL wear, every patient who wears CLs should be considered as a potential patient with GPC.
    • Attending eye doctors should routinely invert and visually inspect lids, especially if a patient who wears CLs has any ocular complaints.
    • Subjective ocular itching; mucus; CLs with significant protein deposits; and CLs that become less comfortable, more mobile, or ride higher underneath the upper lids should all raise suspicion of GPC.

Histologic Findings

Quantitative histologic findings on biopsy specimens from the upper tarsal conjunctivae of patients with either VKC or GPC suggest abnormalities. Mast cells are found in the epithelium, and eosinophils and basophils are found in the epithelium and substantia propria.

Common tear abnormalities include elevated levels of immunoglobulin G (IgG), IgE, and immunoglobulin M (IgM), as well as complement factors, such as C3, factor B, and C3 anaphylatoxin. Specific antigens are thought to cause local production of these mediators. Another feature includes reduced lactoferrin levels in tears (also present in VKC). The significance of these findings is yet to be determined.

More on Conjunctivitis, Giant Papillary

Overview: Conjunctivitis, Giant Papillary
Differential Diagnoses & Workup: Conjunctivitis, Giant Papillary
Treatment & Medication: Conjunctivitis, Giant Papillary
Follow-up: Conjunctivitis, Giant Papillary
Multimedia: Conjunctivitis, Giant Papillary
References
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References

  1. Spring TF. Reaction to hydrophilic lenses. Med J Aust. Mar 23 1974;1(12):449-50. [Medline].

  2. Aakre BM, Ystenaes AE, Doughty MJ, Austrheim Ø, Westerfjell B, Lie MT. A 6-month follow-up of successful refits from daily disposable soft contact lenses to continuous wear of high-Dk silicone-hydrogel lenses. Ophthalmic Physiol Opt. Mar 2004;24(2):130-41. [Medline].

  3. Allansmith MR, Korb DR, Greiner JV. Giant papillary conjunctivitis induced by hard or soft contact lens wear: quantitative histology. Ophthalmology. Aug 1978;85(8):766-78. [Medline].

  4. Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol. May 1977;83(5):697-708. [Medline].

  5. Chang WJ, Tse DT, Rosa RH, Huang A, Johnson TE, Schiffman J. Conjunctival cytology features of giant papillary conjunctivitis associated with ocular prostheses. Ophthal Plast Reconstr Surg. Jan 2005;21(1):39-45. [Medline].

  6. Donshik PC, Ballow M. Tear immunoglobulins in giant papillary conjunctivitis induced by contact lenses. Am J Ophthalmol. Oct 1983;96(4):460-6. [Medline].

  7. Donshik PC, Ballow M, Luistro A, Samartino L. Treatment of contact lens-induced giant papillary conjunctivitis. CLAO J. Oct-Dec 1984;10(4):346-50. [Medline].

  8. Korb DR, Greiner JV, Finnemore VM, Allansmith MR. Treatment of contact lenses with papain. Increase in wearing time in keratoconic patients with papillary conjunctivitis. Arch Ophthalmol. Jan 1983;101(1):48-50. [Medline].

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Further Reading

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Keywords

giant papillary conjunctivitis, GPC, CL GPC, contact lens giant papillary conjunctivitis, contact lens wear, contact lenses, hydrogel contact lenses, soft contact lenses, allergic conjunctivitis, AC, vernal keratoconjunctivitis, VKC, CLPC

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Contributor Information and Disclosures

Author

Barry A Weissman, OD, PhD, FAAO, Chief of Contact Lens Service, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles
Barry A Weissman, OD, PhD, FAAO is a member of the following medical societies: American Academy of Optometry and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

Karen K Yeung, OD, FAAO, Director of Optometry, Arthur Ashe Student Health and Wellness Center, University of California at Los Angeles
Karen K Yeung, OD, FAAO is a member of the following medical societies: American Academy of Optometry
Disclosure: Nothing to disclose.

Medical Editor

Anastasios J Kanellopoulos, MD, Assistant Program Director, Clinical Associate Professor, Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital, New York University
Anastasios J Kanellopoulos, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, Eye Bank Association of America, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Hospital
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, Eye Bank Association of America, Pennsylvania Medical Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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