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Giant Papillary Conjunctivitis

Most people think of conjunctivitis of the eyes as being very infectious, and that’s very true in general. However there are quite a few eye diseases that come under the umbrella of the name conjunctivitis and some are not infectious at all – giant papillary conjunctivitis being one of them.

There are two main groups of conjunctivitis:

  • Infectious – bacterial, viral and chlamydial
  • Reactive – allergic and giant papillary

The reactive types of conjunctivitis do exactly what their name suggests; they react to a situation such as fumes from chemicals, typically cleaning fluids or pool chemicals, or from natural pollens similar to hay fever sufferers.

Giant papillary conjunctivitis (GPC) occurs when the eye reacts to a foreign body of some kind lodged on the surface of the eye, and since the most frequent “foreign body” these days is a contact lens, the term has become widely and almost solely associated with contact lens wear.

What are the Symptoms?

No part of the body is totally smooth, and the surface of the eye is no exception. The very tiny bumps on the surface are called papillae and if the conjunctiva, the mucous layer on the eye, is compromised by an intrusion from an object, the bumps are aggravated and become larger, or so called “giant”, no doubt giving rise to the term giant papillary conjunctivitis.

If a contact lens wearer begins to feel chronic irritation, redness of the eyes and most importantly is wearing the lenses for gradually reduced amounts of time because of discomfort, then GPC could be to blame, especially if there seems to be no other logical reason for the symptoms such as a bacterial or viral infection.

Contact lenses are quite capable of acting as an intruder if precautions are not taken to minimise likely reactions; these precautions are both educational and practical with respect to cleanliness and hygiene.

The reactions can proceed in stages, beginning with mild discomfort and itchy eyes in addition to mucous in the morning.

Further down the track it’s possible that lenses can appear to have a light coating over them and preceding symptoms seem to be more noticeable toward the end of the day.

Increased coating and swelling of the eyes, together with more mucous being produced than before, means that something needs to be done.

A Strategy for Contact Lens Wearers

A considered strategy is more to the point than treatment when a contact lens wearer is diagnosed with GPC. The first course of action is to stop wearing the contact lenses for a while. This may be quite disconcerting for wearers since they may need to return to using glasses (which may be an old prescription) and then have to explain to people who ask the question: “When did you start wearing glasses?”

Following the rest period the supervising optometrist is likely to recommend a change of contact lens material, period of use and disposal. A re-evaluation of the cleanliness and hygiene procedures would certainly be appropriate, with careful monitoring. The ideal contact lens in these circumstances (and probably in most other circumstances) is a daily disposable contact lens.  Using a brand new lens in your eye everyday dramatically reduces the friction that a reused lens can cause.  You also eliminate the toxic effects of preserved cleaning solutions, which is also a contributor to Giant Papillary Conjunctivitis.

It must be said in conclusion that optometrists are very aware of the possible problems that can arise with the wearing of contact lenses, and that the prevalence of GPC has been significantly reduced. The key to catching Giant Papillary Conjunctivitis early is for your optometrist to regularly evert your top eyelids and look underneath with an instrument called a biomicroscope.

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Comments (2)

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  1. annie martin says:

    Hi,
    I have GPC but do not, nor have I ever, worn contact lenses. Last year I went to an eye doctor about it because I lost eyesight in my right eye suddenly and experienced a lot of pain. He gave me two different kind of drops to put in my eye four times a day, which I tried to do without fail but it still hasn’t gone away. Lately I feel like it’s starting to get worse again. Although the drops helped, I’ve had GPC for probably 3 years now if not longer. What is the cause of this in my case and how can I get it to go away?

    Thanks,

    Annie

    • Jim (http://www NULL.optometrist NULL.com NULL.au) says:

      Hi Annie
      GPC when there are no contact lenses present usually will have some sort of allergic basis.

      Without seeing you of course it is diffcult to make a proper diagnosis and then design an appropriate treatment strategy.

      If your GPC is in fact allergic in nature and it has been treated unsuccessfully I would recommend a mast cell stabilser called Patanol and a strong steroid for a couple of weeks called Prednisolone Forte – this must be prescribed by an Eye Dr.

      Once things settled after a couple of weeks you would discontinue the prednisolone and carry on on with the Patanol.

      If this does not settle things I start to wonder whether the diagnosis is in fact correct??
      Regards
      Dr Jim Kokkinakis

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