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Giant Papillary Conjunctivitis - Causes, Symptoms, Risk Factors, Stages, Complications, Diagnosis and Treatment

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Giant papillary conjunctivitis presents bumpy redness on the inner side of the eyelid. Most commonly caused due to irritation of a foreign body.

Written by

Dr. Sumithra. S

Medically reviewed by

Dr. Prashant Koranmath

Published At November 2, 2022
Reviewed AtNovember 2, 2022

Introduction:

The eyes are the organ of vision. Any damage to the eye's vision affects the quality of life significantly. In day-to-day life, foreign bodies like dust tend to irritate the eye, which can be washed off immediately. In some cases, few foreign bodies like contact lenses or sutures/ stitches tend to cause continuous irritation (continuous rubbing) to the parallel surface of the eyelid, causing redness and bumps. This is called giant papillary conjunctivitis. People wearing contact lenses have the highest risk of acquiring giant papillary conjunctivitis. It can happen at any point, even if that person has been used to contact lenses for a long time. It is seen in both males and females. Giant papillary conjunctivitis has to be treated immediately to eliminate severe damage.

What Causes Giant Papillary Conjunctivitis?

Giant papillary conjunctivitis's causative factor is believed to be a foreign body causing continuous irritation.

They are,

  • Contact lens (soft lens, rigid lens, and hydrogel lens).

  • Artificial eye.

  • Sutures or stitches.

  • Allergy of the solution used to clean the contact lens.

  • Episcleral buckles (a type of eye surgery done to restore detached retina).

  • Protein deposits over the contact lens.

  • Chronic allergies of the eye.

What Are the Symptoms of Giant Papillary Conjunctivitis?

  • Bumps on the inner layer of the eyelid.

  • Redness.

  • Foreign body's presence felt.

  • Itching and irritation.

  • Swollen eyelids.

  • Blurred vision.

  • Droopy eyelids.

  • Presence of mucus.

  • Hyperemia (enlargement of conjunctival vessels).

What Are the Risk Factors of Giant Papillary Conjunctivitis?

  • Improper manufacturing of lens edges.

  • Allergic to contact lens or lens cleaning solutions.

  • Meibomian gland dysfunction (no secretion of oil to lubricate the eye's surface).

What Are the Stages of Giant Papillary Conjunctivitis?

  • The early stages of giant papillary conjunctivitis show mild itching and irritation with redness, several bumps on the inner side of the eyelid will be seen. Smaller amounts of mucus discharge can be noticed.

  • In the severe stages, intense itching and irritation, movement of the lens while blinking, an increase in the number of bumps, and blurred vision can be seen.

  • In advanced cases, the sensation of a foreign body’s presence will be felt. Pain while wearing a contact lens and increased lens movement while blinking is also seen.

What Are the Complications of Giant Papillary Conjunctivitis?

If the condition is left untreated for a long time, the bumps on the inner side of the eyelid tend to rub on the surface of the eye resulting in severe damage to the cornea.

What Are the Possible Differential Diagnoses?

  • Viral conjunctivitis.

  • Bacterial conjunctivitis.

  • Congenital ptosis.

  • Chlamydia.

How to Diagnose Giant Papillary Conjunctivitis?

There are not many laboratory tests to diagnose giant papillary conjunctivitis. Physical examination by the eye doctor is the most reliable in this case. The doctor will immediately ask for your contact lens history once the signs are seen.

Physical Examination:

A complete examination of the eye shows,

  • Deposits on the contact lens, especially around the edges.

  • The lens tends to move higher beneath the eyelid.

  • On examining the inner side of the eyelids, papillary hypertrophy (bumps present on the inner side of the eyelids) and hyperemia will be seen.

  • The papilla will be small irregular lesions with whitish centers. Nowadays, papilla of size 0.3 mm diameter is considered good for diagnosing giant papillary conjunctivitis. Earlier only 1 mm diameter lesions were considered.

Few doctors will ask the patients to get their immunoglobulin E levels in tears tested.

How to Manage Giant Papillary Conjunctivitis?

Immediate treatment is vital for giant papillary conjunctivitis. If left untreated, it can cause corneal damage resulting in severe vision problems.

Primary management of giant papillary conjunctivitis includes,

  • Antihistamines to ease the allergy.

  • Educating the patient on the importance of contact lens hygiene.

  • Educating the patient on the usage of proper contact lens design.

  • Topical steroids are prescribed in a few cases.

  • Cold compression can ease the symptoms.

Patients with severe giant papillary conjunctivitis will be advised to change the type of lenses used and to use appropriate solutions to clean the lens. If the patient is wearing it as a cosmesis, they can discontinue it for two to four weeks.

In milder cases, patients can continue wearing contact lenses with minor changes.

Surgical Intervention:

  • Surgical care for giant papillary conjunctivitis is infrequent. In some cases, the giant papillary conjunctivitis is surgically removed and replaced with an autologous conjunctival graft covering the conjunctiva's tarsal defect.

  • Patients will be advised to undergo surgery to avoid using contact lenses. Laser surgery of the eye, famously called LASIK (laser-assisted in-situ keratomileusis), has proven good in replacing power glasses and contact lenses.

Follow Up:

Though the condition subsides, the symptoms will take time to resolve completely. It is better to see the doctor for a check-up in a few months to avoid complications.

Prognosis:

The prognosis of giant papillary conjunctivitis is so good. No mortalities are seen.

Around 80 % of the population tends to recover entirely and wear contact lenses again.

Patients with droopy eyelids as a sign tend to retain a white scar for some time.

How to Prevent Giant Papillary Conjunctivitis?

  • Educating the contact lens wearer on how to handle and clean the lenses.

  • Educate them about the prevalence of papillary conjunctivitis and its etiology. So that patients can approach a doctor as soon as they suspect a problem.

  • Wear contact lenses only for the recommended time limit.

  • Using preservative-free lens cleaning solutions.

  • Use a pair of contact lenses only for a short time. Replace it then and there.

  • People prone to giant papillary conjunctivitis can opt for disposable eye lenses and rigid gas permeable lenses.

  • If pollen is found to cause a patient's papillary conjunctivitis, it is better to stay away from grasses and trees.

Conclusion:

This condition can affect anybody at any time. Proper handling of the contact lenses and looking for the signs of irritation and redness with prompt action can prevent the condition to a greater extent.

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Dr. Prashant Koranmath
Dr. Prashant Koranmath

Ophthalmology (Eye Care)

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