Giant Papillary Conjunctivitis Workup

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

Approach Considerations

No laboratory studies are necessary for the diagnosis of giant papillary conjunctivitis (GPC). However, some clinicians advocate screening patients who wear contact lenses for increased levels of immunoglobulin E (IgE) in their tears.

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Histologic Findings

Quantitative histologic findings of GPC suggest multiple abnormalities.

In patients with GPC, the conjunctival epithelium and substantia propria have increased presence of degranulating mast cells, plasma cells, neutrophils, lymphocytes, basophils, and eosinophils. Although the density of inflammatory cells may not change much between healthy patients and patients with GPC, the increase in tissue mass due to the disease means that the number of inflammatory cells doubles. [15] Levels of decay-accelerating factor, which inhibits C3 amplification in the complement cascade, is decreased in patients with GPC, [16] whereas lactoferrin levels (also present in VKC) are increased, [17, 18] as are neutrophilic chemotactic factor, [19] leukotriene, [20] and eotaxin. [21] The tear film of patients with GPC also have elevated levels of histamine, [22] immunoglobulin G (IgG), IgE, and immunoglobulin M (IgM), [23] as well as complement factors, such as C3, factor B, and C3 anaphylatoxin. [24] Increased levels of exotoxin, which attracts eosinophils, and increased tear immunoglobulins IgG and IgE correlate with the severity of the papillary reaction.

Zhong et al found that the membranous epithelial cells that participate in the binding, uptake, and translocation of antigens in mucosa-associated lymphoid tissue over-proliferate during the course of this disease. In addition, increased lymphocytes give rise to the conjunctival changes in GPC. [25]

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 GPC.

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