Contact Lens-Induced Papillary Conjunctivitis (CLPC)

Definition:

Giant papillary conjunctivitis (GPC) is a type of allergic conjunctivitis characterized by prolonged mechanical irritation in the eye caused by a foreign body especially contact lens. The term “Giant papillary” refers to large bumps that are formed under the eyelid due to constant irritation by foreign body. So GPC is an eye irritation, not an infection that results in an uncomfortable, swollen and red eye.

Affected population

GPC is very common in contact lens wearers and about 20-30% users are affected by this depending upon the duration of use of contact lens and frequency of their replacement. Moreover the users of soft contact lens experience this irritation more as compared to users of hard contact lens.

Risk factors of GPC:

  • Prolonged and excessive use of same contact lens
  • Heat sterilization, poor cleaning, thick or rough contact lens edge
  • Recent eye surgery that involved sutures
  • Eye implants or other such devices like artificial eye lens
  • Recent exposure to conjunctivitis or an upper respiratory tract infection or STD
  • Family history of allergic conditions

Causes of GPC

As GPC is just an irritation, its cause is related to anything that will cause discomfort to the eye. It may include:

  • Allergy to the chemicals in contact lens solutions
  • Debris on the surface of contact lenses
  • An allergic reaction to pollen or other allergens in the air
  • Corneal scar
  • Loose surgical stitch
  • Foreign bodies in the eye

Symptoms of GPC

GPC causes inflammation of the conjunctiva and most of its symptoms revolve around conjunctivitis only. But in addition to this, the symptoms are also associated with the causative factor of mechanical irritation in the eye. Giant papillary conjunctivitis can follow seasonality similar to that of environmental allergies. Patient of GPC may complain of the following:

  • Large bumps on the inside of eyelid
  • Increase in contact lens soilage
  • Eye pain
  • Redness and tearing of eye
  • Mucous discharge in tears
  • Itchy, swollen or scratchy eyes
  • Painful sensitivity to light
  • Matting of eyelashes
  • Pus or watery or mucous discharge especially in morning
  • Changing vision
  • Foreign body sensation in the eye
  • Eye discomfort
  • Drooping eyelids
  • Reduced or blurred vision
  • Excessive movement of contact lens than usual on blinking
  • Short period tolerance of contact lens

Diagnosis of GPC

In most of the cases, investigations are not usually required, and diagnosis of GPC is made on the basis of the clinical history and examination of the eye by:

  • An ophthalmoscope or slit-lamp for a detailed study of the eye. The doctor may need to retract or evert the eyelid to examine the underside of the eyelid.
  • Examination (culture) of conjunctival scrapings to rule out infectious cause.

In addition to these, sometimes additional tests may be required to rule out the presence of other similar conditions.

Treatment of GPC

Treatment of GPC starts with finding and eliminating the underlying cause like removal of suture or changing or reducing the use of contact lens etc. But some cases may require specific treatment like:

  • Oral antihistamines and mast cell stabilizers
  • Topical antihistamines and mast cell stabilisers
  • Lubricating or anti-inflammatory eye-drops, and ointments
  • Topical NSAIDS
  • Steroids
  • Immunomodulating agents
  • Immunotherapy (allergy shots) in case of severe allergic attack that does not respond well to treatment

Complications of GPC

  • Prolonged discomfort, mental & emotional stress
  • Corneal damage
  • Corneal scarring
  • Permanent damage to the eye or vision
  • Bacterial or viral (herpes) infections