Excerpt from Conjunctivitis, Giant Papillary

Synonyms, Key Words, and Related Terms: giant papillary conjunctivitis, GPC, CL GPC, contact lens giant papillary conjunctivitis, contact lens wear, contact lenses, hydrogel contact lenses, soft contact lenses, allergic conjunctivitis, AC, vernal keratoconjunctivitis, VKC

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Background: Giant papillary conjunctivitis (GPC) is a common complication of contact lens (CL) wear. Spring first described GPC in association with CL use in 1974. Papillary changes can occur in the ocular tarsal palpebral conjunctivae as part of an immunoglobulin E (IgE)-mediated hypersensitivity reaction.

Prior to the popularization of hydrogel (soft) CLs in the past 3 decades, this reaction primarily was seen as allergic conjunctivitis (AC) or vernal keratoconjunctivitis (VKC). VKC is a seasonal atopic disease in young people (more common in boys), which occasionally becomes severe and leads to shield corneal ulcers and other complications. GPC related to CL wear never leads to the severe tissue morbidity of VKC.

Papillary changes in the tarsal conjunctiva have been associated with the use of all types of CLs (eg, rigid, hydrogel, scleral, prosthetic). Similar reactions have been noted with ocular prostheses, extruding scleral buckles, exposed ocular sutures, and even elevated corneal scars. When the small papillae coalesce with expanding internal collections of inflammatory cells and when the lesions reach a diameter of at least 1.0 mm, the condition is referred to as giant.

Pathophysiology: The antigens responsible for GPC have not been identified. From circumstantial evidence, the initiating event is believed to be mechanical irritation of the tarsal conjunctiva of the upper lids, followed by histologic changes in the tissue (mast cell degranulation and typical secondary inflammatory cascade).

Frequency:

In the US: Hydrogel CLs appear to result in an overall prevalence of GPC of approximately 20%. New silicone hydrogel CLs may be more prone to GPC development, perhaps because of their mechanical stiffness or their higher propensity for deposition. Heat sterilization, poor cleaning, rough CL edges, and extended wearing times favor development of GPC. Rigorous cleaning (particularly with enzymes), peroxide disinfection, decreased wear times, and increased rates of CL replacement (perhaps daily) appear to reduce the prevalence of GPC among hydrogel CL users. Rigid CL wear appears to result in a prevalence of approximately 5%; increased enzyme cleaning appears prophylactic.

Internationally: No differences are reported; the prevalence is similar to that in the United States.

Mortality/Morbidity: GPC is not associated with any mortality.

Ptosis of the upper lids and decreased CL tolerance can occur.

GPC has been a common cause for permanent CL intolerance; a frustrating occurrence, considering the demographics and habits of CL users.

Sex: Both sexes develop GPC.

Age: GPC can be more aggressive in children who wear CLs.