Conjunctivitis is a very common reason for experiencing an uncomfortable, red eye. There are a number of causes for conjunctivitis, including bacteria, viruses and, importantly, allergies. Allergic conjunctivitis affects the conjunctiva of the eye. The conjunctiva refers to the thin, translucent lining of the eyeball and the undersurface of the eyelids.
Giant papillary conjunctivitis (GPC) is a type of allergic conjunctivitis. In GPC, a foreign body causes prolonged mechanical irritation, which results in a reaction in the eye. Most commonly, contact lenses are the foreign body causing the irritation.
Giant papillary conjunctivitis, commonly referred to as GPC, is a condition in which the inner lining of the eyelid (known as the palpebral conjunctiva) becomes inflamed and small bumps develop.
These small bumps — known as papillae are small bumps — often form in response to some type of chronic irritation, like wearing contact lenses. In GPC, the bumps grow and combine, forming very large bumps that sometimes resemble a cobblestone appearance.
People with GPC complain of redness, whitish discharge, light sensitivity and eye itching that is worse when they remove their contact lenses.
Symptoms of Giant Papillary Conjunctivitis
The following symptoms can be signs of GPC:
- Itchy eyes
- Increased mucous production
- Desire to remove contact lenses earlier in the day
- Gritty, foreign body sensation upon removal of contact lenses
In addition to the symptoms above, you may also notice that your contacts tend to move around a lot or don’t fit as perfectly as they used to.
Giant papillary conjunctivitis (GPC)The doctor will begin with by looking at the external eye and eyelids for any signs of eyelid involvement such as dermatitis. To examine the underside of your eyelid, the doctor may need to retract or evert the eyelid. This is a painless, although slightly uncomfortable, process.
The doctor will ask you to look down while a cotton swab (Q-tip) is placed horizontally on the upper eyelid. The doctor will then gently grasp the upper lid eyelashes and pull the eyelid out and up, gently rolling it over the cotton swab to see the under-surface of your eyelid.
The doctor may also use an ophthalmoscope to view the back of your eye, or a slit-lamp microscope to see the front structures of your eye. Both of these are painless, routine examinations.
Causes of Giant Papillary Conjunctivitis
Although giant papillary conjunctivitis sometimes resembles other eye allergies in appearance, it is thought to be caused by certain proteins that build up on contact lenses over time. GPC can occur in people who wear soft lenses or rigid lenses and can come on suddenly or develop gradually.
The large papillae under the eyelids act as little fingers that grab the lens and cause excessive upward movement.
Papillae are more common in contact lens wearers who do not follow proper cleaning and disinfection routines or who overwear their contact lenses.
People who have asthma, chronic allergies or hayfever tend to be more prone to developing GPC.
GPC can also be caused from the constant act of blinking over a contact lens. The eye interprets the contact lens as a foreign body and a mild type of mechanical trauma occurs.
At some point, the eye’s inflammatory processes kick in and the result is GPC. GPC can also occur in people who wear an ocular prosthesis, or in an eye irritated by a suture from prior eye surgery.
Giant papillary conjunctivitis (GPC)Age and gender do not seem to affect the likelihood of having GPC; nor does there appear to be any strong association with other allergic conditions.
As GPC represents a reaction in response to foreign body irritating the eye, factors such as the use of contact lenses, recent eye surgery involving sutures (stitches), and having an artificial eye lens are all associated with the development of GPC.
There is evidence that the development of GPC is influenced by how often contact lenses are changed. Contact lens wearers who replace their lenses more frequently appear less likely to develop GPC than those who replace their lenses less often.
Diagnosis of Giant Papillary Conjunctivitis
Your eye doctor will take a careful history and listen to your complaints. He or she will then observe your eyes and contact lenses under a slit lamp, a special upright microscope.
Your eye doctor will flip your upper eyelid outward so that the conjunctiva, the inner lining of the eyelid, can be easily seen (this is painless). Your doctor may also instill a yellow dye to temporarily stain the surface eye tissue to aid in making a diagnosis.
Treatment of Giant Papillary Conjunctivitis
Lose the contacts. Your doctor will ask you to discontinue wearing contact lenses, at least temporarily, as the best solution for GPC is to get rid of whatever is causing the irritation.
While contact lens wearers are generally not very happy to hear this, it does speed healing. It may only take a few weeks or as much as 6-8 months of not wearing contact lenses for the condition to completely resolve. At the very minimum, it may be important to reduce your wearing time to only a few hours per day.
Find a new cleaning solution. You may be asked to switch to a better disinfecting and cleaning solution. Peroxide-based cleaning soltions are slightly more complicated to use but do a much better job of not only killing bacteria and viruses, but also of removing any debris that can cause irritation.
Try a new contact lens. Changing from conventional or monthly disposable contact lenses to daily disposables often helps considerably. When you wear a brand new lens every day, your lens does not have much of a chance to build up proteins that you have become allergic to.
Use prescription eye medications. Your eye doctor may prescribe steroid eye drops to lessen the inflammation. Steroids work very well for most sufferers.
If your doctor prescribes topical steroid drops be sure to follow specific instructions, as steroids used in the wrong way can be harmful. A combination mast-cell stabilizer/antihistamine eye drop can often help considerably and are safe for most people to use every day.
The prognosis for GPC is generally favourable and permanent visual loss is not experienced. Ceasing contact lens use improves the symptoms.
Over 90% of people will be able to tolerate contact lenses again, provided measures such as frequent lens replacement, swapping to rigid contact lenses, improved cleaning regimes and topical anti-inflammatory medications are used.