Giant Papillary Conjunctivitis Workup
- Author: Barry A Weissman, OD, PhD, FAAO; Chief Editor: Hampton Roy, Sr, MD more...
No laboratory studies are necessary for the diagnosis of giant papillary conjunctivitis. However, some authors advocate screening patients who wear contact lenses for increased levels of immunoglobulin E (IgE) in their tears.
Quantitative histologic findings with either VKC or giant papillary conjunctivitis suggest multiple abnormalities.
Neutrophils and lymphocytes are usually present only in the conjunctival epithelium and substantia propria, whereas both mast cells and plasma cells are present in the substantia propria but not the epithelium. Basophils and eosinophils are not usually found in either tissue. However, in giant papillary conjunctivitis, degranulating mast cells are found in the epithelium, and both eosinophils and basophils are found in the epithelium and substantia propria. The predominant normal skin (and small intestine) subtype of mast cell, or mast cell with both tryptase and chymase (MCtc), is found in patients with giant papillary conjunctivitis, whereas the mast cell subtype with only tryptase (MCt), which is usually the predominant subtype of mast cell in the lung, is found in the substantial propria of the conjunctiva in VKC. Also, MCt depends on T lymphocytes, whereas MCtc does not.
Although the density of inflammatory cells may not change much between healthy patients and patients with giant papillary conjunctivitis, the increase in tissue mass due to the disease means that the number of inflammatory cells doubles.
Common tear abnormalities found in giant papillary conjunctivitis include elevated levels of histamine, immunoglobulin G (IgG), IgE, and immunoglobulin M (IgM), as well as complement factors, such as C3, factor B, and C3 anaphylatoxin.
Decay-accelerating factor, which inhibits C3 amplification in the complement cascade, is decreased in patients with giant papillary conjunctivitis, whereas lactoferrin (also present in VKC) is increased,[17, 18] as is neutrophilic chemotactic factor, leukotriene, and eotaxin, a chemokine that attracts eosinophils.
Zhong et al also found that the membranous epithelial cells (M cells) that participate in the binding, uptake, and translocation of antigens in mucosa associated lymphoid tissue (MALT) overproliferate during the course of this disease and, in addition to increased lymphocytes, give rise to the conjunctival changes in giant papillary conjunctivitis.
These multiple changes, regardless of whether the initiating insult is mechanical or immunologic, document the substantial inflammatory activities that result in the clinical picture of contact lens–associated giant papillary conjunctivitis.
Allansmith MR, Korb DR, Greiner JV. Giant papillary conjunctivitis induced by hard or soft contact lens wear: quantitative histology. Ophthalmology. 1978 Aug. 85(8):766-78. [Medline].
Allansmith MR, Ross RM. Giant papillary conjunctivitis. Int Ophthalmol Clin. 1988. 28(4):309-16.
Donshik PC, Ehlers WH, Ballow M. Giant papillary conjunctivitis. Immunol Allergy Clin North Am. 2008 Feb. 28(1):83-103, vi. [Medline].
Leonardi A, Bogacka E, Fauquert JL, Kowalski ML, Groblewska A, Jedrzejczak-Czechowicz M, et al. Ocular allergy: recognizing and diagnosing hypersensitivity disorders of the ocular surface. Allergy. 2012 Nov. 67 (11):1327-37. [Medline].
Forister JF, Forister EF, Yeung KK, Ye P, Chung MY, Tsui A, et al. Prevalence of contact lens-related complications: UCLA contact lens study. Eye Contact Lens. 2009 Jul. 35(4):176-80. [Medline].
Dunn JP Jr, Weissman BA, Mondino BJ, Arnold AC. Giant papillary conjunctivitis associated with elevated corneal deposits. Cornea. 1990 Oct. 9(4):357-8. [Medline].
Skotnitsky CC, Naduvilath TJ, Sweeney DF, Sankaridurg PR. Two presentations of contact lens-induced papillary conjunctivitis (CLPC) in hydrogel lens wear: local and general. Optom Vis Sci. 2006 Jan. 83 (1):27-36. [Medline].
Donshik PC, Ballow M, Luistro A, Samartino L. Treatment of contact lens-induced giant papillary conjunctivitis. CLAO J. 1984 Oct-Dec. 10(4):346-50. [Medline].
Tagliaferri A, Love TE, Szczotka-Flynn LB. Risk factors for contact lens-induced papillary conjunctivitis associated with silicone hydrogel contact lens wear. Eye Contact Lens. 2014 May. 40 (3):117-22. [Medline].
Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol. 1977 May. 83(5):697-708. [Medline].
Irani AM, Burtus I, Tabbar KF, et al. Human conjunctival mast cells; distribution of MCT and MCTC in vernal conjunctivitis and giant papillary conjunctivitis. J Allergy Clin Immunol. 1990. 86(1):34-40.
Greiner JV, Covington HI, Allansmith MR. Surface morphology of the human upper tarsal conjunctiva. Am J Ophthalmol. 1977 Jun. 83(6):892-905. [Medline].
Abelson MB, Soter NA, Simon MA, Dohlman J, Allansmith MR. Histamine in human tears. Am J Ophthalmol. 1977 Mar. 83(3):417-8. [Medline].
Donshik PC, Ballow M. Tear immunoglobulins in giant papillary conjunctivitis induced by contact lenses. Am J Ophthalmol. 1983 Oct. 96(4):460-6. [Medline].
Ballow M, Donshik PC, Mendelson I. Complement proteins and C3 anaphylatoxin in the tears of patients with contact lens associated conjunctivitis. J Allergy Clin Immunol. 1985. 76(3):473-6.
Szczotka LB, Cocuzzi E, Medof ME. Decay-accelerating factor in tears of contact lens wearers and patients with contact lens-associated complications. Optom Vis Sci. 2000 Nov. 77(11):586-91. [Medline].
Ballow M, Donshik PC, Rapacz P, Samartino L. Tear lactoferrin levels in patients with external inflammatory ocular disease. Invest Ophthalmol Vis Sci. 1987 Mar. 28(3):543-5. [Medline].
Rapacz P, Tedesco J, Donshik PC, Ballow M. Tear lysozyme and lactoferrin levels in giant papillary conjunctivitis and vernal conjunctivitis. CLAO J. 1988 Oct-Dec. 14(4):207-9. [Medline].
Elgebaly SA, Donshik PC, Rahhal F, Williams W. Neutrophil chemotactic factors in the tears of giant papillary conjunctivitis patients. Invest Ophthalmol Vis Sci. 1991 Jan. 32(1):208-13. [Medline].
Irkeç MT, Orhan M, Erdener U. Role of tear inflammatory mediators in contact lens-associated giant papillary conjunctivitis in soft contact lens wearers. Ocul Immunol Inflamm. 1999 Mar. 7(1):35-8. [Medline].
Moschos MM, Eperon S, Guex-Crosier Y. Increased eotaxin in tears of patients wearing contact lenses. Cornea. 2004 Nov. 23(8):771-5. [Medline].
Zhong X, Liu H, Pu A, Xia X, Zhou X. M cells are involved in pathogenesis of human contact lens-associated giant papillary conjunctivitis. Arch Immunol Ther Exp (Warsz). 2007 May-Jun. 55(3):173-7. [Medline]. [Full Text].
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. 1993 Apr. 12(4):313-21. [Medline].
Khurana S, Sharma N, Agarwal T, Chawla B, Velpandian T, Tandon R, et al. Comparison of olopatadine and fluorometholone in contact lens-induced papillary conjunctivitis. Eye Contact Lens. 2010 Jul. 36 (4):210-4. [Medline].
Diao H, She Z, Cao D, Wang Z, Lin Z. Comparison of tacrolimus, fluorometholone, and saline in mild-to-moderate contact lens-induced papillary conjunctivitis. Adv Ther. 2012 Jul. 29 (7):645-53. [Medline].
Kymionis GD, Goldman D, Ide T, Yoo SH. Tacrolimus ointment 0.03% in the eye for treatment of giant papillary conjunctivitis. Cornea. 2008 Feb. 27 (2):228-9. [Medline].
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. 1983 Jan. 101(1):48-50. [Medline].
Kruger CJ, Ehlers WH, Luistro AE, Donshik PC. Treatment of giant papillary conjunctivitis with cromolyn sodium. CLAO J. 1992 Jan. 18(1):46-8. [Medline].
Spring TF. Reaction to hydrophilic lenses. Med J Aust. 1974 Mar 23. 1(12):449-50. [Medline].
Porazinski AD, Donshik PC. Giant papillary conjunctivitis in frequent replacement contact lens wearers: a retrospective study. CLAO J. 1999 Jul. 25 (3):142-7. [Medline].