Giant papillary conjunctivitis
- Pedram Hamrah, MD
Pedram Hamrah, MD
- New England Eye Center/Tufts Medical Center
- Tufts University School of Medicine
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
- Section Editors
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy; Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
There are five main types of ocular allergy: seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), and giant papillary conjunctivitis (GPC). GPC is a noninfectious inflammatory disorder that represents a reaction to lid movement over a foreign substance, such as contact lenses. It is characterized by foreign-body sensation on the upper tarsus, associated with formation of "giant" (>1 mm) papillae. GPC is reviewed here. Other contact lens-related complications are discussed separately. (See "Complications of contact lenses".)
VKC and AKC are chronic, bilateral, and severe forms of allergic inflammation affecting the ocular surface. These two relatively uncommon types of allergic eye disease can cause severe damage to the ocular surface, leading to corneal scarring and vision loss if not treated properly. VKC and AKC are discussed in detail separately. (See "Vernal keratoconjunctivitis" and "Atopic keratoconjunctivitis".)
Seasonal and perennial allergic conjunctivitis, the most common forms of ocular allergy, are also discussed separately. (See "Allergic conjunctivitis: Clinical manifestations and diagnosis".)
Toxic conjunctivitis is not allergic in nature, but it is frequently confused with allergic ocular disease. It develops with protracted use of topical medications, mostly due to preservatives. Toxic conjunctivitis is discussed separately. (See "Toxic conjunctivitis".)
Giant papillary conjunctivitis (GPC) is most commonly associated with wearing of contact lenses, and is seen more frequently with soft, hydrogel lenses rather than rigid, gas permeable (RGP) lenses [1-3]. Approximately 1 to 5 percent of soft contact lens wearers have clinical signs of GPC, and the prevalence is about 10-fold less in rigid lens wearers . This difference in prevalence is probably because allergens adhere more readily to the surface of soft contact lenses. Additional factors that influence the incidence of GPC in contact lens wearers include wearing time of contact lenses, cleaning routine (frequency and types of solutions), and duration of contact lens wear . The average onset of GPC after start of contact lens wear is 10 to 20 months for soft contact lenses and 22 to 90 months for rigid lenses [2,3]. However, symptoms may occur as early as three weeks after the start of contact lens wear.
- Binder PS. The physiologic effects of extended wear soft contact lenses. Ophthalmology 1980; 87:745.
- Allansmith MR, Korb DR, Greiner JV, et al. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol 1977; 83:697.
- Elhers WH, Donshik PC. Giant papillary conjunctivitis. Curr Opin Allergy Clin Immunol 2008; 8:445.
- Forister JF, Forister EF, Yeung KK, et al. Prevalence of contact lens-related complications: UCLA contact lens study. Eye Contact Lens 2009; 35:176.
- Srinivasan BD, Jakobiec FA, Iwamoto T, DeVoe AG. Giant papillary conjunctivitis with ocular prostheses. Arch Ophthalmol 1979; 97:892.
- Robin JB, Regis-Pacheco LF, May WN, et al. Giant papillary conjunctivitis associated with an extruded scleral buckle. Case report. Arch Ophthalmol 1987; 105:619.
- Vengayil S, Vanathi M, Dada T, et al. Filtering bleb-induced giant papillary conjunctivitis. Cont Lens Anterior Eye 2008; 31:41.
- Carlson AN, Wilhelmus KR. Giant papillary conjunctivitis associated with cyanoacrylate glue. Am J Ophthalmol 1987; 104:437.
- Heidemann DG, Dunn SP, Siegal MJ. Unusual causes of giant papillary conjunctivitis. Cornea 1993; 12:78.
- Sugar A, Meyer RF. Giant papillary conjunctivitis after keratoplasty. Am J Ophthalmol 1981; 91:239.
- Allansmith MR, Ross RN. Ocular allergy and mast cell stabilizers. Surv Ophthalmol 1986; 30:229.
- Begley CG, Riggle A, Tuel JA. Association of giant papillary conjunctivitis with seasonal allergies. Optom Vis Sci 1990; 67:192.
- Leonardi A, De Dominicis C, Motterle L. Immunopathogenesis of ocular allergy: a schematic approach to different clinical entities. Curr Opin Allergy Clin Immunol 2007; 7:429.
- Allansmith MR, Korb DR, Greiner JV. Giant papillary conjunctivitis induced by hard or soft contact lens wear: quantitative histology. Ophthalmology 1978; 85:766.
- Zhong X, Liu H, Pu A, et al. M cells are involved in pathogenesis of human contact lens-associated giant papillary conjunctivitis. Arch Immunol Ther Exp (Warsz) 2007; 55:173.
- Irkeç MT, Orhan M, Erdener U. Role of tear inflammatory mediators in contact lens-associated giant papillary conjunctivitis in soft contact lens wearers. Ocul Immunol Inflamm 1999; 7:35.
- Calder VL, Jolly G, Hingorani M, et al. Cytokine production and mRNA expression by conjunctival T-cell lines in chronic allergic eye disease. Clin Exp Allergy 1999; 29:1214.
- Bozkurt B, Akyurek N, Irkec M, et al. Immunohistochemical findings in prosthesis-associated giant papillary conjunctivitis. Clin Exp Ophthalmol 2007; 35:535.
- Shoji J, Inada N, Sawa M. Antibody array-generated cytokine profiles of tears of patients with vernal keratoconjunctivitis or giant papillary conjunctivitis. Jpn J Ophthalmol 2006; 50:195.
- Moschos MM, Eperon S, Guex-Crosier Y. Increased eotaxin in tears of patients wearing contact lenses. Cornea 2004; 23:771.
- Donshik PC, Ballow M, Luistro A, Samartino L. Treatment of contact lens-induced giant papillary conjunctivitis. CLAO J 1984; 10:346.
- Richard NR, Anderson JA, Tasevska ZG, Binder PS. Evaluation of tear protein deposits on contact lenses from patients with and without giant papillary conjunctivitis. CLAO J 1992; 18:143.
- Donshik PC, Porazinski AD. Giant papillary conjunctivitis in frequent-replacement contact lens wearers: a retrospective study. Trans Am Ophthalmol Soc 1999; 97:205.
- Donshik PC. Giant papillary conjunctivitis. Trans Am Ophthalmol Soc 1994; 92:687.
- Hayes VY, Schnider CM, Veys J. An evaluation of 1-day disposable contact lens wear in a population of allergy sufferers. Cont Lens Anterior Eye 2003; 26:85.
- Meisler DM, Berzins UJ, Krachmer JH, Stock EL. Cromolyn treatment of giant papillary conjunctivitis. Arch Ophthalmol 1982; 100:1608.
- Iwasaki W, Kosaka Y, Momose T, Yasuda T. Absorption of topical disodium cromoglycate and its preservatives by soft contact lenses. CLAO J 1988; 14:155.
- Kruger CJ, Ehlers WH, Luistro AE, Donshik PC. Treatment of giant papillary conjunctivitis with cromolyn sodium. CLAO J 1992; 18:46.
- Pavesio CE, Decory HH. Treatment of ocular inflammatory conditions with loteprednol etabonate. Br J Ophthalmol 2008; 92:455.
- Friedlaender MH, Howes J. A double-masked, placebo-controlled evaluation of the efficacy and safety of loteprednol etabonate in the treatment of giant papillary conjunctivitis. The Loteprednol Etabonate Giant Papillary Conjunctivitis Study Group I. Am J Ophthalmol 1997; 123:455.
- Asbell P, Howes J. A double-masked, placebo-controlled evaluation of the efficacy and safety of loteprednol etabonate in the treatment of giant papillary conjunctivitis. CLAO J 1997; 23:31.
- Bartlett JD, Howes JF, Ghormley NR, et al. Safety and efficacy of loteprednol etabonate for treatment of papillae in contact lens-associated giant papillary conjunctivitis. Curr Eye Res 1993; 12:313.