Giant Papillary Conjunctivitis (GPC)

Fig 3: Giant papillary conjunctivitis (gpc) grade #1

One of the most common forms of contact lens related anterior segment disease, GPC is felt to have both a mechanical and immunogenic etiology. The mechanical component is supported by cases of unilateral GPC in patients with ocular prosthesis or with exposed sutures in unilateral penetrating keratoplasty. The immunogenic theory is supported by histologic evidence of both immediate and delayed hypersensitivity. Patients with GPC often complain of itching, discharge, excessive contact lens movement, variable vision, and contact lens spoilage (figure 3).

Management of GPC has evolved considerably in recent years. Lens discontinuation is recommended, however, the use of daily disposable lenses during the acute therapeutic phase is acceptable. In addition to contact lens discontinuation or replacement, symptomatic relief can be accomplished with the use of cool compresses QID and frequent ocular irrigation. Therapeutic adjuncts include antihistamines / decongestants and topical steroids for acute symptoms. Secondary adjuncts include topical non-steroidals and aspirin for prostaglandin inhibition. Finally, mast cell stabilizers play a role in the long term suppression of GPC. Though patients often report symptomatic relief within the first week of treatment, clinical evidence of GPC can persist for months. Undoubtedly, the mainstay of GPC management involves successfully refitting the patient. Traditionally, patients with GPC have been successfully refit with spoilage resistant materials such as tetrafilcon, crofilcon, and a new addition, omafilcon. In recent years, many GPC patients have been successfully managed with disposable or frequent replacement lenses. Obviously, daily disposable lenses offer minimal spoilage. In disposable, frequent replacement, or traditional lens use the patient is best served by using an enzyme if lenses are kept longer than one week. Finally, one should not discount the mechanical component of GPC. Some patients with soft lens induced GPC are destined to recurrence by virtue of the size and geometry of these lenses. In this case, a refit into rigid gas permeable lenses is advisable. Rigid gas permeable edge design should be uniform from anterior to posterior surface with a well rounded contour, to create adequate tear exchange and minimize patient sensation. Hand polishing may be a necessary modification to lessen mechanical insult.

In the differential diagnosis of GPC, one must be cognizant of the potential for vernal conjunctivitis. Though these two conditions can be very similar in both presenting symptoms and clinical findings there are some subtle differences. Vernal conjunctivitis generally affects preadolescent males, is found more commonly in hot dry climates, and has a seasonal predilection for the spring months. Additionally, vernal conjunctivitis papillae tend to be flatter and more polygonal, and can present with associated limbal Trantas dots and/or punctate keratitis.

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