Giant Papillary Conjunctivitis – GPC

Overview

Giant papillary conjunctivitis (GPC) is an allergic reaction of the eyelid. It occurs when one or several small round bumps (papillae) develop on the underside of the eyelid.  This is in response to contact lenses or solutions.

The inside of the eyelid is also called the palpebral conjunctiva. These bumps develop when the upper lid rubs over something foreign in the eye. The term giant refers to the bumps, or papillae, being larger than 1 millimeter (mm) in size.

There are two types of GPC, primary and secondary. Both are responses to allergens but have different causes.

Primary GPC has two types which are:

 Vernal Keratoconjunctivitis (VKC)

Atopic Keratoconjunctivitis (AKC)

The two types of primary GPC have many similarities. They differ by having different primary causes and the age and manner of symptom onset.

Secondary GPC is caused by something in the eye that’s irritating the inside of the eyelid, such as contact lenses or a suture.

Symptoms

No matter what type of GPC you have, the symptoms are similar. They may include:

 bumps that begin to form on the underside of your upper eyelid

itching

feeling like there’s a foreign object in your eye

eye redness

forming excess mucus

swelling

blurry vision

The symptoms of GPC will increase and become more severe in later stages.

Stages of GPC

In the early stages of giant papillary conjunctivitis, the symptoms may not bother you very much. The early stage symptoms include:

smaller bumps on the underside of your upper eyelid

mild itching

mild redness of the eye

small amounts of excess mucus in the eye

In the severe stages of GPC, the symptoms become more uncomfortable. These symptoms may include:

an increase in the number or size of the bumps

more intense itching

blurred vision

excess mucus developing more quickly and in larger amounts

movement of your contact lens when you blink

In the advanced stage of GPC, the symptoms usually become intolerable. These symptoms include:

additional bumps appearing on the underside of the eyelid

an intolerable sensation of a foreign body in your eye

pain when wearing your contact lenses

excess mucus becoming strings or even sheets

your eyes may stick closed by the excess mucus when you wake up in the morning

excess deposits on your contact lenses

contact lenses may cloud soon after being inserted into your eye

increased movement of a contact lens when you blink

Possible causes

Primary GPC is caused by allergens. If you have primary GPC, you’ll most likely have seasonal allergies, asthma, eczema, or another allergy-related condition.

Vernal keratoconjunctivitis (VKC)

VKC is a chronic condition and usually affects those between the ages of 6-18. Usually, your symptoms will come and go based on seasonal allergies.

Atopic keratoconjunctivitis (AKC)

AKC affects those with atopic eczema that starts when they’re young. However, the symptoms in their eyes usually don’t start until later in adulthood.

Secondary GPC

The most common cause of secondary giant papillary conjunctivitis is the use of contact lenses. More specifically with the use of soft contact lenses. If you wear soft contact lenses, you are 10 times more likely to develop GPC when compared to those who wear hard contacts. The reason for this increase may be because allergens are more likely to stick to soft lenses than hard lenses.

There are approximately 12 million people who wear contact lenses. Out of them, 1 to 5 percent will develop GPC at some point.

Contact lenses are considered prosthetic devices. Other eye or ocular prostheses can cause GPC, as well as any exposed stitches you may have from an eye injury or procedure. Also, certain contact lens solutions can play a role in causing GPC.

Treatment

If your GPC is caused by wearing soft contact lenses, the quickest way to treat the condition is to switch to wearing eyeglasses or hard contact lenses instead of soft contacts. However, these options aren’t usually preferred by many people.

Some people may also be able to manage or eliminate GPC by switching between contacts and eyeglasses. Alternating can give the eye time to rest and reduce the irritation caused by the soft contacts. However, there are other methods and types of treatment for giant papillary conjunctivitis.

Practice proper lens care

Education on proper care, treatment, and cleansing of your contact lenses may help to treat your GPC. Proper lens cleaning tips include:

Use preservative-free cleaning solutions.

Clean your lenses thoroughly every time you take them out.

Always rinse and store your contact in fresh, clean disinfecting solution.

If you have GPC, sterilizing your contacts with contact lens solution containing hydrogen peroxide usually works well.

Clean with a proteolytic enzyme at least once per week, more often if recommended by your doctor.

Replace your contact lenses regularly, as directed by your eye doctor.

Change the type or design of your lenses

You can change the type or design of your lenses to help lower or remove your risk. You can do this by wearing daily disposable contact lenses or by using rigid gas-permeable (RGP) lenses instead of soft lenses.

Stop wearing contacts temporarily

If you don’t want to stop wearing your contacts permanently, you may be able to just stop temporarily. Then, once your symptoms clear up and you wait an additional five days, you may be able to resume wearing your contacts.

Use prescribed eye drops

In some cases, cromolyn sodium drops may be prescribed to apply while wearing your contacts. These drops are usually only used if other treatments haven’t helped.

Treating primary GPC

The preferred treatment for primary GPC is cromolyn sodium and lodoxamide. Other treatment options for both types of primary GPC include:

Antihistamines. Antihistamines may work for some, but may not be strong enough for others.

Topical steroids. Although these are prescribed, they can’t be used long term due to negative side effects associated with long-term use.

Topical cyclosporine.

Possible complications and when to see your doctor

If left untreated, giant papillary conjunctivitis can cause damage to the eye. The bumps on the underside of your eyelid cause damage by rubbing the surface of the eye. This rubbing can damage the cornea.

You should make an appointment with your doctor as soon as you notice any symptoms of GPC to avoid the condition getting worse.

Outlook

GPC can be treated, managed, and in most cases, reversed. Seeing your eye doctor as soon as you notice symptoms can shorten the treatment time and the severity of your condition. Getting treatment and following your doctor’s treatment plan closely can help you to avoid any damage to your eye.

Treatment (continued)

GPC can be a significant problem.  It appears to be a reaction to the contact lenses or solutions.Treatment of GPC is based on the severity of the condition and the amount of patient discomfort.

Mild GPC Treatment

GPC develops slowly over time.  In the early stages, if an eye doctor everts the upper lid, he is able to see subtle bumps or papillae.  This is considered mild GPC.  At this time, a change in lens brand, and or solution brand, avoiding overwear with strict adherence to manufacturer replacement guidelines or changing to daily lenses or removing extended lenses at night may allow for continued wear without complications.

More Severe GPC Treatment

The giant papillae are related to irritation and inflammation must be treated medically to decrease or resolve the GPC.   The antiinflamatory treatment of choice is topical steroid drops.  There are many brands with each having advantages and disadvantages.  We prefer  Lotemax® (loteprednol etabonate ophthalmic suspension 0.5% by Bausch & Lomb).  We prescribe this medicine due to its excellent anti-inflammatory properties and its increased safety profile of less risk of causing increased intraocular pressure compared to other corticosteroid eye drops.

More Options

Avoidance of contact lenses is the mainstay.  This can be accomplished by spectacles or corrective eye surgery such as LASIK, PRK, Clear Lens Exchange or and Implantable Contact Lens.    Print out this page for $100 off any of the above procedures or call 866-295-2020.  We have offices in the midwest and west.

To decrease the chances of developing GPC always replace your contact lenses at the prescribed and recommended intervals and use the contact lens solutions recommended by your doctor