contact lens case reports
A Case of Non-Lens-Related GPC
BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO
Clinically, we divide giant papillary conjunctivitis (GPC) into two categories. The first occurs in conditions such as vernal or allergic conjunctivitis in which no foreign body is present. The second occurs in the presence of foreign bodies such as rigid or soft lenses, exposed corneal or scleral sutures and ocular prosthetics.
Regardless of the underlying condition, patient symptoms frequently include mucous discharge and itching. The clinical signs often begin as a slight "velvet" appearance to the upper tarsal plate that with time can evolve into elevated, giant papillae.
While contact lenses remain at the top of the list as causative factors for GPC, it's important to remember that other foreign bodies such as exposed sutures and ocular prosthetics can induce significant tarsal plate changes (Figure 1). With the lids blinking across the ocular surface approximately 4.5 million times per year, papillary changes are not at all uncommon. You should routinely evert lids especially in the presence of any foreign material.
Figure 1. Suture-induced GPC (top). Prosthetic-induced GPC (bottom).
Our patient was a 36-year-old male with a three-year history of an ocular prosthesis following a traumatic injury to his right eye. His fellow eye was 20/15 with a –1.75DS prescription, and he wore glasses for correction and protection. He presented with symptoms of itching and mucous discharge classic for GPC. Lid eversion revealed significant tarsal plate differences with the right lid more inflamed and the presence of giant papillae (Figure 2).
Figure 2. Patient with prosthetic-induced GPC. Note the significant inflammation on the right tarsal plate.
The mechanisms for prosthetic-induced GPC are multifactorial and include surface deposition in conjunction with long wearing periods. Additionally, individual reactivity to the foreign body may be heightened secondary to a concurrent allergic disposition.
With regard to treatment, all efforts should be directed toward increasing the biocompatibility of the prosthesis. This begins by asking the ocularist to thoroughly polish the PMMA-based prosthesis to remove any existing surface debris and scratches. The patient can then manage future deposition with a 30-minute cleaning in Menicon's Progent protein remover for GP lenses. The Progent cleaner is currently FDA-approved as an in-office cleaning and disinfecting system. However, given the unique nature of the situation, we felt comfortable instructing our patient in the proper use of the product at home.
Treatment of the prosthesis can be augmented with appropriate short- and long-term medical therapies that include ocular lubricants to maintain the cleanliness of the prosthesis and to dilute any antigens. Additional therapies may include topical antihistamine/mast cell stabilizers and/or a pulse dose of a topical corticosteroid. CLS
Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Paragon Vision Sciences. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision.