Giant papillary conjunctivitis (GPC) is also known as contact lens-induced papillary conjunctivitis (CLPC) because it is the most common symptom with people who wear contact lenses. GPC forms small nodules on the inner side of the eyelids as a result of foreign body irritation. Moreover, people who have any eye implants or stitches after eye surgery can be affected by GPC.
The signs and symptoms of giant papillary conjunctivitis may include:
- Large bumps on the inside of the eyelid
- Itchy and scratchy eyes
- Light sensitivity
- Vision changes
- Lenses moving more than usual when blinking
Giant papillary conjunctivitis affects 1 to 5 percent of the users of soft contact lenses in the USA and 1 percent of the users of rigid contact lenses. The problem comes with the hard contact lenses because nearly 10% of American users have elevated papillae larger than 0.3 millimeters. The average time from the first moment of putting contact lenses before developing GPC is 8 months for soft lenses and 8 years for hard lenses. That is why the wearer has to follow the instructions of the doctors and pharmacists when buying the lenses.
The Risk Factors for Giant Papillary Conjunctivitis
An individual who puts any functional object or implant in the eye that stays for a long period of time can be put to a risk of developing giant papillary conjunctivitis. Some examples are:
- The use of contact lens – regardless of the type of contact lens used, either hard or soft, proper care management should be observed. Refrain from using unclean and damaged lenses, sleeping with contact lenses on, and using inappropriate solutions to keep the lenses to avoid irritation or infection that will eventually lead to GPC.
- Dry eye syndrome – is one of the common discomforts experienced by people who wear contact lenses.
- Sleeping with contact lenses – a collection of debris and potentially harmful bacteria can set in since our eyes cannot flush them while we are sleeping. If we are awake, our eyes are able to get rid of unwanted objects through the production of tears.
- Family history with this issue - when other family members are sensitive to such allergens, a person is more prone to develop GPC.
- Allergies such as asthma and hay fever – an underlying sensitivity or disease can also trigger giant papillary conjunctivitis.
How is Giant Papillary Conjunctivitis Diagnosed?
If the person has any symptoms like itching, sand-like feeling inside the eye, blurred vision, or a discharge of watery mucus, he or she should visit an ophthalmologist who will diagnose the problem. The specialist doctor will perform tests to get a definitive diagnosis.
Every person who wears contact lenses is considered as a potential GPC patient. If GPC is diagnosed, the patient has to stop using his or her contact lenses for two or four weeks. Sometimes, the patients miss the symptoms and can be misdiagnosed with some other conditions like allergic reaction or eye dryness. However, many of the patients diagnosed with GPC reported the symptoms long before the appearance of the papillae in their eyes. Your doctor may request for additional investigations to rule out other possible underlying diseases or conditions.
- Physical exam - your doctor or ophthalmologist will conduct an examination to your eyes and assess your medical history.
- Slit-lamp microscopy – can be used for a more detailed study of the eye. This type of eye exam includes checking other parts of the eyes such as eyelids, eyelashes, lens, cornea, retina, iris, and sclera.
- Conjunctival cytology – is a diagnostic tool to secure a conjunctival specimen for culture examination to rule out the infectious cause.
- Differential diagnoses - Conjunctivitis can be in other forms and should be considered to dismiss other types of eye diseases. Conjunctivitis can either be due to allergic reactions, bacterial infection, infections that are of viral or fungal in origin, or caused by congenital ptosis,
Giant Papillary Conjunctivitis Complications
There are some possible complications if giant papillary conjunctivitis is left untreated. Some of them include:
- Extended discomfort
- Emotional stress
- Possible damage to the eye
- Scarring of the cornea
- Infections caused by bacteria or viral in nature, particularly in the case of herpes
- Chronic problem for people who always use contact lenses
Treating Giant Papillary Conjunctivitis
The treatment of giant papillary conjunctivitis is complex and can be hard for both the patient and the doctor. The goal of the treatment is to allow the patient to continue wearing the contact lenses after the treatment. In many patients, giant papillary conjunctivitis can be controlled and they can continue to wear the same type of contact lenses. However, they must try to keep the contact lenses clean and properly stored.
Moreover, the doctors can prescribe different types of contact lenses or different designs for each eye. By the time of the treatment, the patient has to avoid wearing contact lenses. Cold compress on the eye can help in reducing the discomfort. Drugs and medications can stabilize the symptoms and immunotherapy can prevent the body from reacting to external triggers.
Although unnecessary in most mild cases of giant papillary conjunctivitis, the use of topical steroids is prescribed. In severe cases of giant papillary conjunctivitis, steroids are very useful. However, loteprednol, which is a mild steroid, can be used instead of using the stronger ones to avoid the risk of developing glaucoma among patients suffering from giant papillary conjunctivitis.
Other treatment measures for giant papillary conjunctivitis include:
- Using eyeglasses instead of contact lenses
- Cold compress on the affected eyes
- Antihistamines as needed
- Lubricating eye drops or ointments
- Allergen immunotherapy
How to Prevent Giant Papillary Conjunctivitis
In general, the prevention of giant papillary conjunctivitis is easy. The following are simple instructions to prevent GPC:
- There must be no overuse of the contact lenses. The patient should not be wearing the lenses longer than recommended.
- Keep the lenses clean and regularly changed every 3-6 months.
- Proper cleaning and keeping of the contact lenses using lubricant eye drops.
- Use the type of lenses that suit you – use disposables as much as possible and refrain from buying cheap ones.
- Have regular medical checkups if you have conditions like asthma or eczema.
- Observe proper hygiene by always washing your hands before putting or removing the contact lenses.
- Avoid frequent sun exposure.
- Stay away from irritants such as smoke, dust, and pollen. One should stay away from trees and grass during the pollen season
- Use an air conditioner at home.
- Resist on rubbing your eyes because it will only make the symptoms worse.
- Following the eventual changes in the eye after wearing the contact lenses.
- If you suspect some visible changes that can lead to a serious medical condition, urgently visit and consult an ophthalmologist for a diagnosis.
The symptoms can be treated with good outcomes, but the condition can be long-standing and may come back or recur at some point in your life. Eighty percent of the patients can wear contact lenses again after the treatment. There are also many alternative medicine therapies and home remedies that can ease the discomfort of GPC. However, those are not medically approved as a proper treatment.