What are the other Names for this Condition? (Also known as/Synonyms)

• Contact Lens-Induced Papillary Conjunctivitis (CLPC)
• Giant Papillary Conjunctivitides
• GPC

What is Giant Papillary Conjunctivitis? (Definition/Background Information)

• Giant Papillary Conjunctivitis (GPC) is the formation of small-sized nodules (called ‘papillae’, 0.3-1mm size or larger) on the inner side of the eyelids (on the conjunctiva); leading to foreign body sensation, persistent irritation, discharge of watery mucus, among other symptoms
• GPC arises due to a continuous rubbing of the conjunctiva by any foreign body with which it is in constant physical contact. Most commonly this abnormal development is observed in regular users of contact lens; hence, it is also called Contact Lens-Induced Papillary Conjunctivitis
• This inflammatory condition is a constant annoyance and is often long-standing. The symptoms clear only after the mechanical friction on the eyelid membrane ceases. GPC is not infectious
• Conjunctivitis is inflammation of conjunctiva of the eye, which is the membrane covering the white region of the eye
• In Conjunctivitis the white part of the eye turns red or pink, and hence it is known as Pink Eye. The infection may affect either one, or both the eyes, and is accompanied by inflammation, irritation, with watery discharge from the eyes. Under normal circumstances, Conjunctivitis does not affect vision

Who gets Giant Papillary Conjunctivitis? (Age and Sex Distribution)

• Individuals who are regular contact lens wearers, or have any eye devices or implants, suffer exposed stitches (unnoticed) due to any eye surgery; all for a prolonged period may be affected by Giant Papillary Conjunctivitis
• Anywhere between 5-20% (the percentage varying with the contact lens type used) of frequent contact lens users, are found to suffer from GPC
• Both male and female genders are equally affected by GPC. Children who wear contact lenses, suffer the most severe form of this eye disorder

What are the Risk Factors for Giant Papillary Conjunctivitis? (Predisposing Factors)

Any implant or functionally-placed object in the eye, for an extended period of time is a potential risk factor for Giant Papillary Conjunctivitis. These include:

• Contact lens (both hard & soft lens variety): Lack of proper cleaning, using worn-out lenses, lens with rough edges, wearing lenses while sleeping, using unapproved (or stale) solutions to store lenses, are all factors that encourage the formation of papillae
• Protruding suture stubs (from an eye operation) that continuously rub against the eyelid
• Eye implants or other such devices placed to correct eye-related defects; like a sclera buckle, artificial eye
• An individual with a family history of allergies (like when parents are allergic to such allergens), is more prone to the condition
• Sometimes, the presence of other diseases or disorders (like asthma, eczema, hay fever) may initiate Giant Papillary Conjunctivitis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Giant Papillary Conjunctivitis? (Etiology)

• Giant Papillary Conjunctivitis is essentially an allergic inflammatory response caused by the constant friction between the conjunctiva and other physical device/implant/suture present in the eye against which it rubs, as the eyes blink regularly or close, for a prolonged period. This is described as a kind of mechanical micro-trauma
• A chronic use of contact lens (of any type) is the most frequent causal factor for GPC. In some cases the curvature of the lens may be inadequate (it may be too flat), or it is not a correct fit
• Sometimes the material of the contact lens (or the chemical it is stored in), or certain deposits that form over the contact lens, cause the build-up of certain proteins in the eye. Such situations may also bring about some changes in the soft tissue of the eye, which triggers an allergic reaction
• When the allergen comes into contact with the conjunctiva and mucus membranes lining the eyes, the body releases histamine (an organic chemical) triggering the allergy symptoms. This may be due to an extremely sensitive body immune system

What are the Signs and Symptoms of Giant Papillary Conjunctivitis?

Giant Papillary Conjunctivitis develops over time, with constant rubbing of the inner part of the eyelid(s) against a physical object. Signs and symptoms of GPC include:

• Itching and redness of the eye(s), burning sensation
• Eye pain and inflammation of the eyelid; with gritty feeling of sand-like particle inside the eye
• Regular discharge of watery mucus from the eyes, blurred vision
• Contact lens users may often find their lens uncomfortable, slipping out of position (as they blink), sticking to the inside of the eyelid, or requiring frequent cleaning

How is Giant Papillary Conjunctivitis Diagnosed?

Giant Papillary Conjunctivitis is diagnosed as follows:

• The ophthalmologist or physician performs an eye examination and evaluates the patient’s medical history
• Slit lamp exam (if necessary), for a detailed study of the eye
• Examination of conjunctival scrapings; culture to rule out infectious cause
• Differential diagnosis of other types of conjunctivitis should be considered, in order to eliminate other eye conditions

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Giant Papillary Conjunctivitis?

Complications may arise if Giant Papillary Conjunctivitis is not treated. The complications could include:

• Prolonged discomfort, mental & emotional stress
• Corneal damage, scar
• Damage to the eye
• Bacterial or viral (herpes) infections can occur superimposed
• GPC could be a chronic problem for those who regularly wear contact lenses

How is Giant Papillary Conjunctivitis Treated?

Management measures for Giant Papillary Conjunctivitis include controlling factors responsible for an allergic trigger, treating the symptoms, and moderating the body immune response system. They are as follows:

• GPC is primarily managed by avoiding contact lens wear for several weeks, or as required (and using eye glasses instead)
• Correction of other factors such as implants or exposed sutures, are considered; if they are the causative factors of GPC
• Application of cold compress can help reduce discomfort
• If necessary, medications such as oral antihistamines and mast cell stabilizers (a non-steroid drug), may be used depending on the type of symptoms
• Other drugs to provide relief from symptoms are corticosteroids (prescribed in severe cases only), lubricating or anti-inflammatory eye-drops, and ointments
• Immunotherapy (allergy shots) is used to desensitize the body and prevent it from overreacting to such external triggers. This method is usually considered, in case of a severe allergic attack that does not respond well to treatment, or when other medical disorders are also present
• Proper choice and care of contact lenses (including ensuring proper hygiene), frequent changing of the lens set (using daily or weekly disposable lenses), are steps that can help prevent recurrence of the condition

How can Giant Papillary Conjunctivitis be Prevented?

• Giant Papillary Conjunctivitis is most often caused by regular over-usage of contact lens combined with lack of proper cleanliness, hygiene, and maintenance of the pair (of lenses). If these factors are taken care of, then GPC may be completely avoided or prevented
• Educate yourself to the basic use, care, and handling, of contact lenses. Also be aware of GPC, and its signs & symptoms
• Some of the contact lens rules would be: Evaluate the type of lens that is best for you (avoid cheap ones), use disposable lenses (if possible, use daily disposables), limit ‘wear-time’ to a minimum (follow a need-based usage), strictly adhere to proper lens care and cleaning instructions, store them in approved chemical solutions (peroxide solutions, enzymes, are considered to be good), ensure that they are correct-fit, are not damaged, edges are in good shape, etc.
• If GPC is an allergic (eye) response due to the presence of a protein build-up; then consider reevaluating the lens (material) type worn, and change them accordingly
• In order to preserve the eye condition, always maintain hygiene and wash hands regularly. Prevent aggravation of the condition by staying out of the sun, keeping away from dust and smoke. Also, avoid frequently touching or rubbing the eyes

What is the Prognosis of Giant Papillary Conjunctivitis? (Outcomes/Resolutions)

• Giant Papillary Conjunctivitis, mild or severe, can be treated and it has an excellent outcome. But, the condition may be long-standing and it may recur if the set of sequence that led to its initial development, repeats again
• Once the condition is completely treated, most individuals (about 80% of them) can resume wearing (appropriate) contact lenses
• Without treatment, or if there are repeated episodes of GPC, then there may be complications. It may also cause great discomfort, and in some extreme cases affect the vision. However, such situations are extremely infrequent

Additional and Relevant Useful Information for Giant Papillary Conjunctivitis:

• Many alternatives medicine therapies, natural therapy, or home remedies are available to ease the discomfort of Giant Papillary Conjunctivitis. However, such treatment methods are not a proven science and should not be substituted for a qualified healthcare provider’s medical advice