Giant papillary conjunctivitis (GPC) can be a frustrating condition for both practitioners and patients. It progresses silently in the asymptomatic stage, but at diagnosis it is often at a level of symptoms and severity that is difficult to manage. Forister et al (2009) identified it as one of the most common contact lens complications with both soft and GP lenses. The treatment for GPC varies, but it can include a refitting of the contact lens modality; it may be of some surprise that a good option to consider is GP lenses.

GPC Etiology and Frequency

The difficulty in managing GPC is largely due to the fact that the exact etiology is still debatable. In contact lens wearers, it is likely due to mechanical trauma to the conjunctiva from lens edge movement and friction combined with an inflammatory, IgE-mediated hypersensitivity reaction to the surface properties of the lens (Barnett, 2015). As such, a large number of variables may need to be addressed when managing GPC, including prescription anti-inflammatory topical medications, adjusting lens fitting properties such as edge design and/or material, increasing lens replacement intervals, or changing lens modalities altogether (Donshik, 2003). Ideal lens material properties include low water content and non-ionic/non-reactive surfaces, as these lenses tend to accrue fewer deposits (Barnett, 2015).

Alipour et al (2017) report the incidence of GPC in GP lens wearers (15%) to be significantly less compared to the incidence in soft lens wearers (85%). Other research seems to corroborate this conclusion (Barnett, 2015; Douglas et al, 1988; Forister et al, 2009). This may be due to favorable GP lens material or fitting characteristics (such as a smaller overall diameter that avoids certain areas of the palpebral conjunctiva, as in Figure 1) or to better patient compliance with cleaning and avoidance of extended wear.

Figure 1. The smaller overall diameter of a corneal GP lens may help reduce the incidence of GPC by avoiding certain areas of the palpebral conjunctiva.

Managing GP-Related GPC

When a GP lens wearer does develop GPC, treatment can differ from that for a soft lens wearer, particularly if the patient is unable to switch to a lens with a more frequent replacement schedule due to the need for a specialty/therapeutic lens. Strict attention must be paid to the lens fit, especially the lens-to-upper-lid fitting relationship and the edge lift. Douglas et al (1988) found that lower oxygen permeability (Dk) extended the time interval between the initial fitting of GP lenses and GPC onset.

Scleral lens wear can also be associated with GPC, particularly in lenses that have overly flat superior haptics and excessive superior edge lift. This can not only cause lens discomfort, it can also possibly increase mucous debris in the post-lens fluid reservoir (Johns et al, 2017).

An Option to Consider

While GP lenses do not grant patients immunity from GPC, they do have relatively positive material characteristics and adjustable fitting parameters that may provide relief for a patient who wishes to continue contact lens wear. Ongoing advances in GP lens surface treatments and scleral lens haptic designs continue to make GP lenses a valid consideration when GPC arises. CLS

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