Dr. Orwa Nasser MD MPH - Giant Papillary Conjunctivitis

Giant Papillary Conjunctivitis

Giant papillary conjunctivitis is a non-infectious inflammatory condition affecting the inner surface of the eyelids. It is characterized by enlarged papillae greater than one millimeter in diameter on the palpebral conjunctiva. This condition commonly occurs in contact lens wearers but may also develop due to ocular prosthetics or exposed sutures. It is not contagious and results from chronic mechanical irritation and immune response.

Symptoms: Symptoms typically develop gradually and may affect both eyes.

    ·    Eye redness.

    ·    Itching or irritation.

    ·    Foreign-body sensation.

    ·    Excess mucus or stringy discharge.

    ·    Blurred vision due to discharge.

    ·    Drooping or swollen eyelids.

    ·    Discomfort while wearing contact lenses.

    ·    Increased movement of contact lenses during blinking.

Causes: Giant papillary conjunctivitis develops due to chronic irritation of the inner eyelid surface.

·    Contact lens-related irritation: Mechanical friction from contact lenses stimulates inflammation. Protein and debris deposits on lenses increase immune response. Extended wear and poor hygiene raise the risk.

·    Allergic hypersensitivity: Some individuals develop hypersensitivity to lens deposits or cleaning solutions.

·    Mechanical irritation from foreign bodies: Ocular prosthetics, exposed sutures, or other foreign materials may trigger inflammation.

Diagnosis and Tests:

·    Diagnosis is based on history and clinical examination.

·    The eyelids are everted to visualize enlarged papillae.

·    Slit-lamp examination assesses conjunctival inflammation.

·    Fluorescein staining may assist in evaluation.

Management and Treatment: Treatment focuses on eliminating irritation and controlling inflammation.

·    Contact lens modification:

o   Temporary discontinuation of contact lenses allows healing.

o   Switching to daily disposable lenses may reduce recurrence.

o   Improved hygiene and reduced wear time are recommended.

·    Medicated eye drops:

o   Antihistamine or mast cell stabilizer drops reduce inflammation.

o   Nonsteroidal anti-inflammatory drops may provide symptom relief.

o   Short-term topical corticosteroids may be used in severe cases under supervision.

·    Supportive care:

o   Artificial tears may rinse irritants and improve comfort.

o   Avoiding eye rubbing reduces further irritation.

Prognosis:

·    With appropriate management, most patients experience significant improvement within weeks.

·    Vision typically returns to baseline once inflammation subsides.

·    Recurrence may occur if contact lens habits are not modified.

Prevention:

·    Good contact lens hygiene reduces risk.

·    Regular lens replacement prevents deposit buildup.

·    Avoiding extended or overnight wear lowers irritation.

·    Early evaluation of symptoms prevents progression.

When Should I See My Healthcare Provider? Seek evaluation if redness, itching, discharge, or contact lens intolerance persists.

When Should I Go to the Emergency Room? Go immediately if severe pain, sudden vision loss, or signs of infection develop.

What Questions Should I Ask My Healthcare Provider?

    ·    Is this giant papillary conjunctivitis or another condition?

    ·    Are my contact lenses contributing to symptoms?

    ·    What treatment is most appropriate?

    ·    When can I safely resume lens wear?

    ·    How can I prevent recurrence?

Key Takeaways:

    ·    Giant papillary conjunctivitis is a non-infectious inflammatory eyelid condition.

    ·    It is commonly associated with contact lens wear.

    ·    Symptoms include redness, itching, and mucus discharge.

    ·    Treatment focuses on reducing irritation and inflammation.

    ·    Proper lens hygiene helps prevent recurrence.