Giant Papillary Conjunctivitis Clinical Presentation

Updated: Oct 18, 2018
  • Author: Karen K Yeung, OD, FAAO; Chief Editor: Hampton Roy, Sr, MD  more...
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Presentation

History

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. Patients often report that the contact lenses move noticeably with each blink.

GPC can follow a seasonality pattern similar to that of environmental allergies. Environmental allergens may exasperate contact lens–induced GPC in patients with atopy. [12] GPC development does not correlate with ocular bacterial bioburden. [12]

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Physical Examination

Clinicians commonly note increased deposition on contact lenses. In addition, 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.

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. [13] Originally, the papillae of the upper tarsal conjunctiva were thought to have to be at least 1 mm to diagnose GPC. 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 classic symptoms.

GPC that is associated with hydrogel contact lenses is more commonly at the fold of the everted lid, spreading over the entire tarsal conjunctival surface.

GPC 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 provides evidence for the mechanical etiology hypothesis.

Silicone hydrogel lenses tend to induce more local than general GPC responses, similar to that seen with rigid lens wear.

Attending eye doctors should routinely invert and visually inspect lids, especially in patients who wear contact lenses for 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 for GPC.

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