Giant Papillary Conjunctivitis GPC

Giant papillary conjunctivitis is an allergic reaction resulting in inflammation of the palpebral conjunctiva (thin membrane on the underside of the eyelids).  Commonly called GPC by eye doctors, it is usually associated with contact lens wear or people with ocular prostheses (artificial eyes) or corneal sutures.  GPC is one of the most common complications of wearing contact lenses.

Causes of GPC Giant Papillary Conjunctivitis

Several factors contribute to GPC: 

1. An allergic reaction of the palpebral conjunctiva (tissue on the underside the eyelid) to protein deposits on the surface of the contact lens.  The denatured protein initiates an immune response under the upper eyelid in the palpebral conjunctiva.  Protein from the tears of the eyes accumulates on the surface of the contact lens. Some protein and other debris remains on the lens surface even after a lens is cleaned.  One of the main reasons disposable contact lenses were invented was to eliminate GPC.  Frequent replacement of lenses minimizes or eliminates the problem because the lenses are disposed of prior to significant accumulation of protein and debris on the lens surface. Generally speaking, the more often a lens is replaced, the less likely GPC will occur.  However, the property of the lens material to resist the build-up of protein deposits also factors into the GPC equation.

2. The mechanical irritation or interaction of the eyelid surface and the contact lens surface/lens edge also plays a significant role in the cause of GPC.  There has been a slight increase in GPC cases because silicone hydrogel contact lenses are now frequently prescribed.  Although silicone hydrogel lenses are a significant advancement in contact lens science they are actually stiffer than traditional soft lenses.  The stiffer, more rigid lens surface may in some cases increase the interaction with the eyelid possibly resulting in mechanical irritation and subsequently GPC.  Manufacturers have improved the lens edges and created smoother lens surfaces to minimize this problem and increase patient comfort.

Signs and Symptoms of GPC Giant Papillary Conjunctivitis

The signs and symptoms of GPC include discomfort or awareness of the contact lenses and a reduced tolerance to contact lens wear, redness of the eyes (conjunctival hyperemia), itching, and mucous discharge which may possibly even cause blurred vision if the discharge is heavy. 

The contact lens professionals at Master Eye Associates will evert (turn inside out) the upper eyelid.  If enlarged papillae are visualized under high magnification using slit lamp biomicroscopy the diagnosis can usually be confirmed after ruling out other possible causes of papillary increase including Chlamydial conjunctivitis.

Treatment of GPC Giant Papillary Conjunctivitis

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 so it is often possible for an astute eye doctor to find mild GPC before it becomes a clinically significant issue for the patient.  Treatment for mild cases include possibly changing the lens brand, changing the contact lens solutions, stopping contact lens wear for a short time or switching to more frequent disposal of the lenses.

Treatment for More Severe GPC

The inflammation must be controlled and reduced to alleviate GPC.  Control of inflammation is accomplished with the use of corticosteroid eye drops.  Master Eye Associates primarily use 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.

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.