Giant papillary conjunctivitis, a reaction to chronic irritation, may call for a change in contact lens wear or care.
|More questions to Ask
When You Suspect GPC
Giant papillary conjunctivitis is most likely to occur with current contact lens wearers or with previous contact lens wearers. Here are some recommended questions to ask when obtaining a patient history:
• How long have you been wearing contact lenses?
• What is your average daily wearing time?
• Do you sleep in your lenses?
• How often do you replace your lenses?
• Are you using a cleaning or disinfectant system?
• Are you using any eye drops with or without contact lenses?
• Have you ever been treated for lid irritation (GPC) during previous contact lens wear? Was the treatment successful?
Giant papillary conjunctivitis, commonly referred to as GPC, is a condition in which the palpebral conjunctiva becomes inflamed and papillae develop. These small bumps often form in response to some type of chronic irritation, such as wearing contact lenses. In GPC, the bumps grow and combine, forming very large bumps that sometimes resemble a cobblestone appearance.
Symptoms of GPC include itchy eyes, increased production of mucus, a desire to remove contact lenses earlier in the day, and a gritty, foreign-body sensation upon removal of contact lenses. Patients may also notice that their contact lenses tend to move around or don’t fit as perfectly as they used to.
CAUSES OF GPC
GPC is most likely an allergic reaction to deposits that form on the surface of a contact lens rather than the lens itself. Since the lens itself is made from a type of plastic, it is probably not the lens that is the source of the allergy, but rather the proteins and lipids that deposit on the lens. The upper lid is in almost constant contact with the lens, and most of the abnormal changes occur on the inside surface of the upper lid. The large papillae under the eyelids act as little fingers grabbing the lens and causing upward movement.
Papillae are more common in contact lens wearers who do not follow proper cleaning and disinfection routines or who over-wear their contact lenses. 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, resulting is GPC.
Patients who have asthma, chronic allergies or hay fever tend to be more prone to developing GPC. It can also be caused by constantly blinking when wearing contact lenses. It also may occur when a patient wears an ocular prosthesis, or in an eye irritated by a suture from prior eye surgery.
Because GPC is caused by exposure of the conjunctiva to allergens in the contact lenses rather than viral or bacterial infection, it is not contagious.
There are four stages of GPC:
• Preclinical GPC, the earliest stage of this disorder in which certain spots of the eyelid turn red and rough.
• Mild GPC, in which small bumps arise on the eyelid, causing minor difficulties in clear vision.
• Moderate GPC, in which the bumps grow larger than 1 mm in this stage, leading to blurred vision. Patients often find their lenses moving upward as they blink.
• Severe GPC, the acute stage in which vision becomes blurred, and the patient suffers from eyesight problems. This is the result of abnormal movement of contact lens.
To aid in the diagnosis, be sure to take a careful medical history and listen to the patient’s complaints. Each office will have its own patient record form or EHR program. There are several basic areas that should be covered in any history. The patient’s chief complaint is an important part of the history. With GPC, patients may say their eyes are itchy or red, and/or report a burning sensation. Another complaint: eye pain and inflammation of the eyelids or of their eyes feeling gritty, discharge of watery mucus or blurred vision. Ask for more information. Determine how long the complaint has existed, how severe it is, and whether it is better, worse or the same? Can the patient associate the complaint to a time of day or task?
Measure the patient’s visual acuity, observe the contact lens using the slit lamp and document what you observe. This description will aid the doctor in his or her diagnosis.
The doctor will flip the upper eyelid outward so that the conjunctiva, the inner lining of the eyelid, can be easily seen. The doctor may also use a yellow dye to temporarily stain the surface eye tissue to aid in making a diagnosis.
TREATMENT OF GIANT PAPILLARY CONJUNCTIVITIS
There are several possible treatments for GPC. The doctor might tell the patient to:
• Discontinue wearing contact lenses, at least temporarily, to get clear 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 six to eight months of not wearing contact lenses for the condition to completely resolve. At the very minimum, it may be important to reduce the wear time to only a few hours per day.
• Switch to a more effective disinfecting and cleaning solution. Peroxide-based cleaning solutions are slightly more complicated to use but are very effective at killing bacteria and viruses and removing any debris that can cause irritation.
• Try a different kind of contact lens. Changing from conventional or monthly disposable contact lenses to daily disposables often helps considerably. When patients wear daily disposable lenses, there is less of a chance to build up proteins that the patient might be allergic to. (For a listing of daily disposable contact lenses, see “At-A-Glance,” page 28.)
• Use cold compresses. Cold compresses can help to relieve itchiness and soreness of GPC. Instruct the patient to soak a clean washcloth in a container of water filled with ice. Remove the water from the washcloth and apply it against the affected eyelid, repeating this process for five to 10 minutes
• Use prescription eye medications. The doctor may prescribe steroid eye drops to lessen the inflammation. Steroids work very well for most patients. If the doctor prescribes topical steroid drops it is important the patient follows the instructions, as steroids used in the wrong way can be harmful. A combination mast cell stabilizer/antihistamine eye drop can often help considerably and is safe for most patients to use every day.
Most patients with GPC can still wear contact lenses. However, they need to be instructed in the proper contact lens hygiene and wearing habits that will lower the risk of developing GMC.
GIANT PAPILLARY CONJUNCTIVITIS PROGNOSIS
Depending on its severity, GPC typically resolves in one to six weeks—provided the patient does not wear contact lenses during that time. If the patient has chronic GPC, the condition will flare up once the patient resumes contact lens wear. This is why the doctor would suggest wearing daily contact lenses at that time rather than put the patient at risk of developing GPC again from over-wear of lenses.
Roberta Beers, CPOT, is an optometric assistant in Erie, PA.