Giant Papillary Conjunctivitis Workup

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

Histologic Findings

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.[12] 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.[13]

Common tear abnormalities found in giant papillary conjunctivitis include elevated levels of histamine,[14] immunoglobulin G (IgG), IgE, and immunoglobulin M (IgM),[15] as well as complement factors, such as C3, factor B, and C3 anaphylatoxin.[16]

Decay-accelerating factor, which inhibits C3 amplification in the complement cascade, is decreased in patients with giant papillary conjunctivitis,[17] whereas lactoferrin (also present in VKC) is increased,[18, 19] as is neutrophilic chemotactic factor,[20] leukotriene,[21] and eotaxin, a chemokine that attracts eosinophils.[22]

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.[23]

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.

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Approach Considerations

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.

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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, 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

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

  2. 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].

  3. Allansmith MR, Ross RM. Giant papillary conjunctivitis. Int Ophthalmol Clin. 1988;28(4):309-16.

  4. Donshik PC, Ehlers WH, Ballow M. Giant papillary conjunctivitis. Immunol Allergy Clin North Am. Feb 2008;28(1):83-103, vi. [Medline].

  5. 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. Jul 2009;35(4):176-80. [Medline].

  6. Dunn JP Jr, Weissman BA, Mondino BJ, Arnold AC. Giant papillary conjunctivitis associated with elevated corneal deposits. Cornea. Oct 1990;9(4):357-8. [Medline].

  7. Jones L, Senchyna M, Glasier MA, Schickler J, Forbes I, Louie D, et al. Lysozyme and lipid deposition on silicone hydrogel contact lens materials. Eye Contact Lens. Jan 2003;29(1 Suppl):S75-9; discussion S83-4, S192-4. [Medline].

  8. 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. Jan 2006;83(1):27-36. [Medline].

  9. Donshik PC. Giant papillary conjunctivitis. Trans Am Ophthalmol Soc. 1994;92:687-744. [Medline]. [Full Text].

  10. 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].

  11. 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].

  12. 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.

  13. Greiner JV, Covington HI, Allansmith MR. Surface morphology of the human upper tarsal conjunctiva. Am J Ophthalmol. Jun 1977;83(6):892-905. [Medline].

  14. Abelson MB, Soter NA, Simon MA, Dohlman J, Allansmith MR. Histamine in human tears. Am J Ophthalmol. Mar 1977;83(3):417-8. [Medline].

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

  16. 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.

  17. 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. Nov 2000;77(11):586-91. [Medline].

  18. Ballow M, Donshik PC, Rapacz P, Samartino L. Tear lactoferrin levels in patients with external inflammatory ocular disease. Invest Ophthalmol Vis Sci. Mar 1987;28(3):543-5. [Medline].

  19. Rapacz P, Tedesco J, Donshik PC, Ballow M. Tear lysozyme and lactoferrin levels in giant papillary conjunctivitis and vernal conjunctivitis. CLAO J. Oct-Dec 1988;14(4):207-9. [Medline].

  20. Elgebaly SA, Donshik PC, Rahhal F, Williams W. Neutrophil chemotactic factors in the tears of giant papillary conjunctivitis patients. Invest Ophthalmol Vis Sci. Jan 1991;32(1):208-13. [Medline].

  21. 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. Mar 1999;7(1):35-8. [Medline].

  22. Moschos MM, Eperon S, Guex-Crosier Y. Increased eotaxin in tears of patients wearing contact lenses. Cornea. Nov 2004;23(8):771-5. [Medline].

  23. 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). May-Jun 2007;55(3):173-7. [Medline]. [Full Text].

  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.

  26. 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].

  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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