Giant Papillary Conjunctivitis Revisited Treatment Decisions
BY TIMOTHY T. MCMAHON, OD, FAAO
My last column presented an enhanced method of grading GPC severity and "activeness." In this column I will discuss treatment decisions tied to this scale. Recall the three grading criteria: cause, severity and degree of disease activity. Also recall that GPC is an allergic event primarily stimulated by one's own tear proteins. These are forced by a foreign object into deeper layers of the conjunctiva that normally don't see these proteins and can register them as foreign allergens.
You can treat GPC by 1) removing the source (foreign object), 2) cold compresses, 3) antihistamines and decongestants, 4) mast cell wall stabilizers and 5) steroids. Also try more frequent replacement of a patient's lenses if these are part of the picture.
I first group sources into those I can remove and those I can't. Next I look at the severity of the condition. Lastly, I consider the "activeness" of the condition, then I follow the guidelines illustrated in Table 1. I do tend to treat the condition more aggressively when the activity score is higher than the severity score.
To assess treatment effectiveness, evaluate conjunctival edema, injection, mucus discharge, apical staining of papillae and ptosis. The key is improvement in the activity score. The rate of improvement is variable and depends on the presence or absence of the inciting source, sufficiently aggressive therapy, the season and the presence of current active allergic symptoms from other causes such as hay fever. Occurrence and recurrence of GPC is greater during late spring to early fall in the United States.
When is it safe to return to lens wear? I normally want to see a severity score of 2+ or less, and activity score of 1+ or less, as well as an absence of symptoms including mucus in the nasal canthi in the mornings and a resolution of ptosis. For hydrogel wearers not in frequent replacement lenses, I move them into this modality. Discourage extended wear. Recurrence of GPC in extended wear is a virtual certainty.
Dr. McMahon is an associate professor and Director of the Contact Lens Service at the University of Illinois at Chicago Dept. of Ophthalmology & Visual Sciences.