What is Giant Papillary Conjunctivitis?

DEFINITION :

            It is an allergic inflammation affecting the superior tarsal conjunctiva due to mechanical irritation.

ETIOLOGY: Most commonly due to –

                                    1. Soft hydrophilic contact lens use.

                                    2. Protruding suture ends.

                                    3. Ocular prostheses.

               Underlying mechanism is a hypersensitivity reaction (type 1 and 4)

SYMPTOMS :

                                    1. Contact lens intolerance.

                                    2. Itching

                                    3. Watering and mucoid discharge

                                    4. Foreign body sensation

                                    5. Redness

                                    6. Blurring of vision ( occasionally)

SIGNS :

1.      Conjunctival congestion – predominantly in the upper palpebral region with large papillae

·         Macropapillae – 0.3 – 1mm in size

·         Giant papillae – 1-2 mm in size

DIFFERENTIAL DIAGNOSIS :

                                    1. Vernal catarrh

                                    2. Atopic conjunctivitis, allergic conjunctivitis

                                    3. Blepharitis

                                    4. Viral / Bacterial conjunctivitis

                                    5. Other causes of contact lens intolerance eg: poor fit, dry eyes.

TREATMENT :

                                    1. If using contact lens, discontinuing for 2-4 weeks

                                    2. Removal of offending sutures.

                                    3. Cleaning & polishing of any ocular prosthesis and replacing this

                                         with one coated with biocompatible material such as a coat.

                                    4. Topical therapy includes drugs which have a combination of mast

                                          cell stabilizing & antihistamine action.  eg: olopatadine, ketotifen.

                                    5. Artificial tears and decongestants for symptomatic relief.

                                    6. After the acute phase is over, pure mast cell stabilizers can be used.

                                    7. Topical steroids can be administered for a short while and a

                                         subtarsal injection of long-acting steroids maybe needed in severe

                                        cases