Giant Papillary Conjunctivitis Treatment & Management

  • Author: Barry A Weissman, OD, PhD, FAAO; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: May 26, 2011
 

Approach Considerations

Topical steroids can be used in the treatment of giant papillary conjunctivitis but are not necessary in all cases. Contact lens hygiene is an important component in the disease’s deterrence.

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Lens Use and Pharmacologic Management

If severe giant papillary conjunctivitis develops, patients who wear contact lenses purely for cosmesis should discontinue contact lens wear for 2-4 weeks (the interval during which symptoms may begin to reverse and signs improve).

Steroids can be used in these cases.[24, 25] However, combination mast cell stabilizers and antihistamine ophthalmic medications sometimes suffice without exposing the patient to the known risks of topical steroids. Most patients do not require more aggressive treatment.

Use of topical steroid drops, especially for more than a few weeks, is associated with glaucoma, cataracts, and decreased ocular resistance to infection. Topical steroid use is a particular concern in patients with a history of herpetic eye disease. Although topical corticosteroid use is not associated with induction or facilitation of viral recurrence, a fulminant infection could occur if the herpes virus recurs during topical corticosteroid treatment. Increased concerns exist regarding de novo fungal and other viral infections and potentiating bacterial infections.

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) have rarely been associated with corneal melting.

Contact lens use can often resume after improvement in symptoms, but refit wearers of hydrogel contact lenses into disposable contact lenses, especially daily disposable contact lenses.

If daily disposable contact lenses are not available, wearers of hydrogel contact lenses should use peroxide disinfecting solutions with their frequently disposable contact lenses.

Reemphasize contact lens cleaning techniques, especially rubbing with "no-rub" labeled solutions; also educate patients about the nature of this allergic disease.

For mild to moderate giant papillary conjunctivitis, patients can often continue contact lens wear but with the same change in contact lens design and materials, care regimens, and education.

Wearers of rigid and hydrogel contact lenses should use some form of enzyme cleaning, at least twice per week or as frequently as every night.[26] This measure, of course, is unnecessary for patients who use daily disposable hydrogel contact lenses.

Topical mast cell stabilizers and antihistamine combination solutions (eg, olopatadine, Elestat) may offer a pharmacologic adjunctive treatment for these patients, although contact lens cessation is the most effective initial treatment.

Topical steroid and antihistamines may be used synergistically.[25]

Cool compresses can be added to improve symptoms.

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Refractive Surgery

Considering the efficacy and safety of most modern keratorefractive procedures (eg, LASIK), patients who refuse conservative management may consider refractive surgery. This treatment may enable them to avoid contact lenses.

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Prevention

Increased frequency of contact lens replacement (especially daily disposables), rigorous cleaning (particularly with enzymes), peroxide disinfection, decreased wear times, and appropriate/timely professional supervision appear to reduce the prevalence of giant papillary conjunctivitis among users of hydrogel contact lenses.

Increased enzyme cleaning also appears to be prophylactic for wearers of rigid lenses.[2, 3, 4]

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Long-Term Monitoring

Approximately 80% of patients who develop giant papillary conjunctivitis (GPC) with contact lens use can return to comfortable contact lens wear with appropriate treatment.[10] Frequent encouragement by the clinician can be essential, because the symptoms may take a while to subside.

The patient should be frequently monitored while giant papillary conjunctivitis is active, perhaps every few weeks to few months.

Once giant papillary conjunctivitis successfully is managed, patients should receive follow-up care as indicated by other aspects of their ophthalmic and medical situation.

Symptoms may be more important than signs.

Therapeutic effect is evidenced by the subjective return of contact lens tolerance, suppression of ocular itching, decreased objective hyperemia of the tarsal conjunctivae, decreased inflammation of the giant papillae, and lessened mucus in the tears.

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Proceed to Medication
 
 
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, Los Angeles, David Geffen School of Medicine

Barry A Weissman, OD, PhD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association, and Phi Beta Kappa

Disclosure: VSP None Speaking and teaching; Alcon None Speaking and teaching; Vistakon/The Vision Care Institute Grant/research funds support of Fellowship program

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.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching; EyeGate Pharma Consulting; Inspire Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting fee Consulting

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.

References

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  24. Bartlett JD, Howes JF, Ghormley NR, Amos JF, Laibovitz R, Horwitz B. Safety and efficacy of loteprednol etabonate for treatment of papillae in contact lens-associated giant papillary conjunctivitis. Curr Eye Res. Apr 1993;12(4):313-21. [Medline].

  25. Khurrana S, Sharma N, Agorwal T, et al. Comparison of Olopatadine and Fluorometholone in contact lens-induced papillary conjunctivitis. Eye and Contact Lens. 2010;36(4):210-4.

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  27. Kruger CJ, Ehlers WH, Luistro AE, Donshik PC. Treatment of giant papillary conjunctivitis with cromolyn sodium. CLAO J. Jan 1992;18(1):46-8. [Medline].

 
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Very large papillae in the everted upper lid of a patient who wears hydrogel (soft) contact lenses.
Giant papillary conjunctivitis (GPC) response (slightly out of focus) seen in the upper lid of a young patient recovering from cataract extraction with an exposed suture barb (in focus).
 
 
 
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