Conjunctivitis, giant papillary

Giant papillary conjunctivitis. Giant papillary conjunctivitis (GPC) affects both eyes causing contact lens intolerance, itching, heavy discharge, and tearing and red bumps on the underside of the eyelids. 

Contact lens care products can be divided into three categories cleaners, disinfectants, and lubricants. Improperly cleaned lenses can cause discomfort, irritation, decrease in visual acuity, and giant papillary conjunctivitis (GPC). This latter condition often requires discontinuation of lens wear, at least until the symptoms clear. Deposits can also accumulate preservatives from lens care products and produce toxicity and can act as a matrix for microorganism attachment to the lens [317]. Thus, cleaning with the removal of surface debris, tear components, and contaminating microorganisms is one of the most important steps contributing to the safety and efficacy of successful lens wear [318]. 

Horwitz, Safety and efficacy of loteprednol etabonate for treatment of papillae in contact lens-associated giant papillary conjunctivitis, Curr. Eye Res. 12 313 (1993). 

P. Asbell and J. Howes, A double-masked, placebo-controlled evaluation of the efficacy and safety of loteprednol etabonate in the treatment of giant papillary conjunctivitis, CLAO J. 23 31 (1997). 

The anti-inflammatory effect of rimexolone has been compared with placebo after cataract extraction. Rimexolone was both clinically and statistically more effective in suppressing cells, flare, keratin precipitates, and photophobia, with no between-group differences in lOE Rimexolone has not been FDA approved for allergies or giant papillary conjunctivitis. 

Although there are five types of hypersensitivity responses, two of these, types 1 and 1 play a significant role in the pathophysiology of allergic eye disease. The ocular manifestations include seasonal allergic conjunctivitis (SAC), giant papillary conjunctivitis (GPC), vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis, contact dermatitis, and urticaria. These are discussed in Chapter 27. 

Ahmet A, Irkec M, Orhan M, et al. Effect of lodoxamide on tear leukotriene levels in giant papillary conjunctivitis associated with ocular prosthesis. Ocul Immunol Inflamm 1998 6 179-184. 

Polymer-based artificial tears are the most common tear supplementation product used in dry eye treatment. In addition to dry eye, ocular lubricants are used in the treatment of corneal abrasions, ultraviolet keratitis, herpes simplex and zoster keratitis, phlyctenular disease, giant papillary conjunctivitis, superior limbic keratoconjimc-tivitis, vernal disease, adenoviral infections, and other ocular surfece conditions. 

Corneal abrasion (for detailed discussion see Corneal Abrasion) (see Figure 26-14) Giant papillary conjunctivitis (Figure 26-55) Hypersensitivity to CL care solutions (Figure 26-56) Bacterial conjunctivitis... 

Figure 26-55 Giant papillary conjunctivitis secondary to rigid gas-permeable contact lens wear. (Courtesy of Pat Caroline.)...

Giant Papillary Conjunctivitis Signs, Symptoms, and Treatment Considerations... 

AM = morning CL = contact lens Conj = conjunctival D/C = discontinue RGP = rigid gas permeable SPK = superficial punctate keratitis. FromAUansmith MR, Korb DR, Greiner jy et al. Giant papillary conjunctivitis in contact lens wearers.Am J Ophthalmol 1977 83 700. 

Figure 27-4 Localized giant papillary conjunctivitis. (Reprinted with permission Optom Vis Sci 2006 83 31.)...

Donshik PC. Contact lens chemistry and giant papillary conjunctivitis. Eye Contact Lens 2003 29(1S) S37-S39. 

Donshik PC. Giant papillary conjunctivitis. Trans Am Ophthalmol Soc 1994 92 687-744. 

Irani, A.A., Butrus, S.I. and Schwartz, L.B. (1988). Distribution of T and TC mast cell subsets in vernal conjunctivitis (VC) and giant papillary conjunctivitis [Abstract]. NER Allergy Proc. 9, 451. 

The four types of conjunctivitis are viral conjunctivitis, bacterial conjunctivitis, allergic conjunctivitis, and giant papillary conjunctivitis. 

Currently, it is the only corticosteroid approved by the FDA for use in all inflammatory and allergy-related ophthalmic disorders, including inflammation after cataract surgery, uveitis, allergic conjunctivitis, and giant papillary conjunctivitis. Loteprednol etabonate resulted from a classic inactive metabolite-based soft drug approach (103-114). 

Clinical studies proved that it is a safe and effective treatment for contact lens-associated giant papillary conjunctivitis (GPC), seasonal allergic conjunctivitis, postoperative inflammation, or uveitis (101, 102). Based on promising results from animal studies (112-114), loteprednol etabonate is also being developed for treatment of asthma, rhinitis, colitis, and dermatological problems. 

Soft contact lenses, and to a lesser extent hard contact lenses, can accumulate foreign materials on their surfaces and possibly within their polymer matrices. The deposits are composed primarily of substances present in the tear fluid (I). The deposits cloud the lens, cause the wearer discomfort, and may be responsible for a variety of inflammatory conditions including giant papillary conjunctivitis. Manifestations of this syndrome consist of increased mucus, mild itching, decreased lens tolerance, and the development of giant... 

Conjunctivitis is inflammation of the thin, clear membrane that covers the white part of the eye and the eyelids. There are four types of conjunctivitis viral conjunctivitis, bacterial conjunctivitis, allergic conjunctivitis, and giant papillary conjunctivitis. A comeal abrasion is a cut or scratch on the cornea caused by debris, fingernails, contact lenses, or mbbing the eye. Most corneal abrasions heal with the proper treatment. 

GPC is an inflammatory condition that occurs primarily in contact lens wearers. The clinical manifestations include giant papillae in the upper tarsal conjunctiva, increased mucous secretion, itching, and lens intolerance. When GPC occurs with contact lens wear, it is referred to as contact lens papillary conjunctivitis (CLPC). In addition to contact lens wearers, GPC may also affect patients with ocular prostheses or exposed sutures. 

---