Giant papillary conjunctivitis: Causes, symptoms and treatment
What is giant papillary conjunctivitis?
Giant papillary conjunctivitis (GPC) is the formation of papillae, or bumps, under the upper eyelid. It is due to chronic irritation of the conjunctiva inside the eyelid, usually from contact lenses. The conjunctiva, which lines the inner eyelid and white of the eye, also becomes red and inflamed.
In the past, GPC was considered to be an allergic reaction similar to allergic conjunctivitis. It is no longer considered an allergic reaction but, rather, an inflammatory response to a contact lens or another irritant.
What causes giant papillary conjunctivitis?
Giant papillary conjunctivitis caused by friction against the prosthetic eye. [Image credit: Giant papillary conjunctivitis. Permission granted by © 2022 American Academy of Ophthalmology]
GPC is inflammation of the inner eyelid. It is usually caused by chronic irritation from a contact lens sitting on the eye and allergens that are present on the contact lens surface.
Although it is less common, GPC can also be caused by other irritants in the eye. This includes particles trapped under the eyelids, irritation from a prosthetic eye or exposed stitches from eye surgery.
Why do contact lenses cause GPC?
Secretions from the eyes and airborne particles can stick to contact lenses. This can cause the lining under the eyelid to become inflamed and irritated. The bumps, or papillae, under the eyelid are a result of this inflammation. They are called giant because they can be larger than 1mm in size.
In addition, the inner eyelid can become irritated when the eyelid hits the contact lens with every blink. In short, GPC is the result of the eyelid hitting the contact lens plus the body’s response to deposits that have built up on the contact lens.
Both soft and rigid gas-permeable (smaller and harder material) contact lenses can cause GPC. It can even appear after years of wearing contact lenses without prior issues.
Soft contact lenses versus rigid gas-permeable contact lenses
When comparing types of contact lenses, doctors have found that GPC:
Is 10X less common in rigid contact lenses wearers – This may be because the materials that soft contact lenses are made of tend to be easier for particles to stick to.
Occurs in up to 1 out of 20 soft contact lens wearers – Symptoms and signs of GPC can be seen by an eye doctor during a routine eye exam.
Typically occurs after 1-1.5 years in soft contact lens wearers – After beginning contact lens wear, GPC symptoms can occur within months. They can also occur as early as the first few weeks of wear.
Typically appears after 2+ years in rigid contact lens wearers – The likelihood of GPC occurring is much lower for rigid contact lens wearers.
Has the highest occurrence in hydrogel soft contact lens wearers – About 20% have signs of GPC.
Has lower occurrence in rigid gas-permeable contact lens wearers – Only about 5% of all cases of GPC.
Other causes of GPC associated with contact lens wear include:
Allergy to contact lenses and cleaning solution
Need for higher frequency of contact lens replacement
Inadequate cleaning routine
Excessive contact lenses wear time
Improper contact lens material or fit
Studies have shown that people who wear monthly replacement contact lenses have a much higher rate of developing GPC than those who wear contact lenses that are replaced more frequently.
READ MORE: Tips for contact lens wearers
What are symptoms of giant papillary conjunctivitis?
People who develop GPC will find that their eyes begin to feel less comfortable in general. For example, if they are contact lens wearers, they will no longer be able to wear them for as long or without irritation.
GPC can get worse over time. If not managed properly, it can lead to contact lens intolerance or chronic eye discomfort. GPC begins with mild signs and symptoms that become more severe as the condition progresses. Early on, there may be slight irritation and itching or redness. Small bumps may be present on the lining of the upper eyelid.
As GPC progresses, symptoms that an individual may experience include:
General irritation
Burning sensation
Production of mucus secretions
Contact lens wearers with GPC may also experience:
Awareness of contact lens in the eye
Increased movement of contact lens in the eye
Intolerance to contact lens wear
Contact lens wearers with the following conditions are more likely to get GPC:
Asthma
Seasonal or other allergies
Hay fever
In addition, contact lens wearers with GPC who have seasonal allergies may notice an increase in symptoms during allergy season.
READ MORE: Eye allergies: Get relief from itchy, watery eyes
What else can cause symptoms similar to GPC?
The symptoms of GPC are often similar to other forms of conjunctivitis. Some conditions that can have a similar appearance to GPC include:
Seasonal allergic conjunctivitis
Viral conjunctivitis
Bacterial conjunctivitis
Atopic conjunctivitis
READ MORE: Pink eye (conjunctivitis)
An eye doctor can diagnose whether you are experiencing symptoms caused by GPC or another condition.
How is giant papillary conjunctivitis diagnosed?
An eye doctor can diagnose GPC by taking a history of your symptoms and performing an eye exam. They will look for signs associated with GPC, such as large papillae underneath the upper eyelid.
Using a slit lamp, which is an instrument with high magnification and a bright light, an eye doctor can get a close look at the eyes. In order to do this, a doctor may need to stain the eyes with a dye and flip the eyelid.
If you wear contact lenses, an eye doctor may look for deposits on the lens or issues such as poor lens fit or lens damage.
How is giant papillary conjunctivitis treated?
The majority of GPC cases resolve with proper management and treatment. In order to avoid the development of chronic GPC, it is important to see a doctor if you notice symptoms. Chronic GPC can lead to eyelid and cornea damage.
Your doctor may implement the following strategies to manage your GPC:
For contact lens wearers:
Discontinue contact lens wear temporarily
Switch to a different contact lens cleaning system, such as one that is preservative-free, uses hydrogen peroxide or includes a weekly enzymatic cleaner
Switch to daily disposable contact lenses
Switch to rigid gas-permeable contact lenses
Alternate contact lens wear with more frequent glasses wear
General treatment:
Prescribe mast cell stabilizer and antihistamine eye drops
Prescribe corticosteroid eye drops
Remove exposed sutures
Adjust prosthetic eye
How can giant papillary conjunctivitis be prevented?
If you have recently had eye surgery or wear a prosthetic eye and are experiencing symptoms of GPC, schedule an eye appointment so that your eye doctor can promptly address any issues.
If you are a contact lens wearer, it is crucial to see an eye doctor for routine comprehensive eye exams. This will allow early detection of GPC and prevent the condition from progressing to more chronic stages. In addition, follow the contact lens wearing schedule prescribed by your eye doctor. Also, remember to give your eyes some rest by wearing glasses on occasion.
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Giant papillary conjunctivitis. UpToDate. May 2022.
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GPC leads to contact lens instability. Optometry Times. June 2018.
Giant papillary conjunctivitis. Immunology and Allergy Clinics of North America. February 2008.
Giant papillary conjunctivitis. American Academy of Ophthalmology. April 2022.
Treatment of giant papillary conjunctivitis. Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium. National Academies Press. 1991.
Giant papillary conjunctivitis. Columbia University Department of Ophthalmology. Accessed May 2022.
Page published on Wednesday, June 22, 2022
