WHAT IS GIANT PAPILLARY CONJUNCTIVITIS?
Conjunctivitisis an inflammation or infection of the conjunctiva – the pink mucous membrane lining the eyelids and the structures of the eye.
Giant papillary conjunctivitis,also known as GPC, is a condition of the conjunctiva in which the structures known as papillae (glands) become very large in the upper lid. In severe cases, the enlargement of papillae is accompanied by itching and mucus discharge. IT IS NOT CONTAGIOUS.
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| Coating and deposits on soft contact lenses are a common cause of giant papillary conjunctivitis. Giant Bumps under the upper lid causes one not to be able to comfortably wear contact lenses Photos taken by Skowron Eye Care (SEC) |
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| Deposits on a soft lens causing GPC from not following proper replacement schedule. |
WHAT CAUSES GPC?
GPC is commonly associated with wearing contact lenses that are coated or have deposits. For that reason, it is considered a relatively “new” eye condition, having first become a major concern of eyecare professionals in the 1970's. In addition to contact lens wear, GPC may result from wearing an eye prosthesis (artificial eye), or as the result of a protruding or uncovered end of a “stitch remnant,” left exposed after eye surgery.
WHAT ARE THE SYMPTOMS OF GPC?
In the mild stage, reduced contact lens wearing time is the most common symptom. Many factors can affect comfortable wearing time, such as lack of sleep, environmental irritants, or dry eyes. However, persistent loss of wearing time, in the absence of identifiable reasons, may indicate an early stage of giant papillary conjunctivitis.
Four stages of the condition have been identified and described:
Stage 1: Pre-Clinical
The patient has begun to feel discomfort when wearing contacts, but there is no obvious buildup of deposits of the contact lenses. There is a mild increase in the amount of mucus present in the morning and mild itching when lenses are removed.
Stage 2: Early Clinical
Now a light coating of material has been deposited on the lens and enlarged papillae are forming. Additionally, small amounts of mucus are present over the papillae. Mild redness of the eyes occurs and there is an increase in the amount of mucus present on awakening. Itching on removal of lens becomes more severe and the wearer is much more aware of the lens late in the day.
Stage 3: Moderate
There is a medium to heavy coating of deposit material on the lens. The number, size, and elevation of papillae increase; there is a great deal more redness and swelling of the conjunctiva. Moderate to heavy mucus is often present in the morning. Itching on removal of lens may be moderate to severe and may vary on a daily basis.
Stage 4: Severe
The severe stage is accompanied by a heavy deposit of protein on the lens. Papillae increase in size, number, and elevation. Redness, swelling, and mucus production become more severe and some changes in the cornea may be present. Heavy mucus production is noticed on awakening and eyelids may stick together.
GPC - A major disappointment to contact lens wears
Giant papillary conjunctivitis can be a disappointing, discouraging condition since it is primarily caused by long-term use of contact lenses. Some contact lens wearers who have enjoyed lenses for many years become intolerant and must return to glasses.
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| Rigid Gas Permeable lens fogging up Photo by (SEC) |
Preventative measures for those who wear soft lenses should include:
- Good care of your lenses – cleaning, disinfecting, and soaking with solutions recommended by your eyecare professional
- Routine measures such as daily cleaning, as well as weekly cleaning of lenses with an enzymatic solution (to remove protein deposits)
- More frequent replacement of your disposable lenses
- You may need to go to a daily disposable lens
Preventative measures for gas-permeable lenses should include:
- All possible measures for good care of lenses
- Enzymatic cleaning at intervals recommended by your doctor
- See under RGP lenses “Tips on Cleaning”
TREATMENT:
Giant papillary conjunctivitis can be difficult to treat. Discontinuing lens wear is usually required to treat patients that are in stage 3 or 4. Also the instillation of anti-inflammatory eyedrops helps to speed recovery. Decreased wearing time, more frequent lens replacement, or diligent cleaning may be all that is necessary to improve the condition at earlier stages.
The most effective, easiest treatment of giant papillary conjunctivitis is simply to discontinue contact lens wear. When the patient ceases wearing lenses, the symptoms usually disappear with time (weeks to months).
Of course, many contact lens wearers find this an unacceptable solution. It may become more palatable if they understand it need not be forever. If the eyes are given an opportunity to recover, contact lens wear may be possible at a later time. However, even after a break, the problem may recur when lens wear is resumed.
We will work with you and explore every possible alternative. For instance, when eyes have recovered, contacts might be tolerated better if worn on a more limited basis. Another possibility is that a change in the type of lens worn may be beneficial in preventing the occurrence of GPC. Simply replacing the old lenses with new ones is often helpful. Daily disposable lenses are a good option for those who experience problems. These are lenses that are worn once and discarded.
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| Dr. Streiff giving drops to treat GPC |
GIANT PAPILLARY CONJUNCTIVITIS IS EASIER TO PREVENT THAN CURE
Even though we do not know exactly what causes giant papillary conjunctivitis, we do know that protein deposits are likely a contributing factor, so meticulous attention to cleaning is important. In addition, a well-fitted pair of contact lenses is essential to prevent problems such as giant papillary conjunctivitis.
REMEMBER…
Giant papillary conjunctivitis is treatable and there are many options to explore before “giving up” on your contact lenses. Working together, we can explore alternatives for care and develop a plan for continues clear and comfortable vision.
