The term giant papillary conjunctivitis is a long name for a few types of allergic reactions that affect the eyelids. (Learn More)

There are three types of GPC: two types of primary GPC and one secondary type, which is the most common form in the Western world. (Learn More)

Symptoms and causes of each type of GPC are very similar. A particle or foreign object, from pollen to a contact lens, is lodged in the eye, and the eyelid reacts. (Learn More)

It is important to stop wearing contact lenses immediately and get treatment from your eye doctor if you develop symptoms of GPC. Untreated forms can seriously damage vision. (Learn More)

Conjunctivitis

What Is Giant Papillary Conjunctivitis?

Giant papillary conjunctivitis is a lengthy name for what is essentially an allergic reaction in the eye. It is a reaction to foreign objects, from pollen to contact lenses, that leads to an immunological response.

Unlike many forms of conjunctivitis, giant papillary conjunctivitis (GPC) is not contagious. It is not the same as pink eye, which is a bacterial or viral form of conjunctivitis.

Most people who develop this condition contract it because they wear their contact lenses too long — either several days in a row or past when they should be disposed of. In some instances, they develop it because contact lenses are not cleaned properly. Soft contacts are such a common cause of GPC that the condition is also often called contact lens-induced papillary conjunctivitis.

If the underside of the inner eyelid has papules, or several close-together raised bumps, and you also have itching and watering or discharge in and around the eye, you may have GPC. However, you need a diagnosis from a medical professional before beginning treatment for this condition.

Primary and Secondary Giant Papillary Conjunctivitis

man rubbing eyes

If you contract giant papillary conjunctivitis, the most likely cause is soft contact lenses that have been worn for more than four weeks. The body has an immune response to this foreign body, and the inner eyelid becomes inflamed and irritated. However, GPC can also be part of the body’s allergic reaction to nylon or prosthetic materials.

There are two basic types of GPC. Both forms of GPC have many similarities, but they differ in their primary causes and the age of onset.

  1. Vernal keratoconjunctivitis (VKC): This form mostly affects young men, between ages 6 and 12, who live in hot, dry climates like the Middle East, West Africa, and the Mediterranean Basin. It has also been found commonly in Japan, India, and South America. It is considered rare, but not unknown, in North America and Western Europe. VKC is an allergic reaction that is believed to occur when pollen or other grit gets into the eyes. While men are more affected than women, the gender gap decreases with age.
  2. Atopic keratoconjunctivitis (AKC): This form of GPC involves an immune system response alongside a chronic skin disease, like topical eczema or atopic dermatitis (AD). AD affects about 15 to 20 percent of children, and between 1 and 3 percent of adults, worldwide. Peak incidence occurs between 30 and 50 years old, typically involving both eyes at the same time. About 20 to 40 percent of people with AD develop AKC at some point in their lives.

There is also secondary GPC. This type of conjunctivitis is caused by something inside the eye irritating the eyelid, like a contact lens or suture.

The Causes and Symptoms of Giant Papillary Conjunctivitis

The primary symptom of GPC is large, or “giant,” papillae on the superior tarsus — large bumps on the underside of the eyelid. The following are other symptoms:

  • Feeling like something is stuck in your eye
  • Redness
  • Warmth on the upper, lower, or inner eyelid
  • Swelling of the eyelid
  • Drooping eyelid
  • Itchiness
  • Pain in the eyelid
  • Excess watering of the eye
  • Discharge, mucous, or pus in the eye, especially coming from the lid
  • Blurry vision from feeling like something is in your eye
  • Feeling like your contact lens moves up your eyeball when you blink

Typically, the inside of both upper and lower eyelids is smooth. If this texture changes, it could be the first sign of GPC.

This condition can start any time, even after you have safely worn contacts for years. You may not wear contacts, and you can still contract the condition from an allergic reaction to another material, whether it is a foreign particle that ends up in your eye or not.

man with cataracts pinching nose

There are a few potential causes, other than contact lenses, for GPC, such as:

  • An artificial eye or prosthesis inside the eye rubbing against the eyelid.
  • Stitches from an eye area surgery causing irritation.
  • Deposits of proteins or other foreign substances that collect on contact lenses.
  • Chronic eye allergies.
  • Wearing contact lenses and also having serious seasonal allergies, asthma, or hay fever.
  • Getting something you are allergic to in your eye.

If you develop symptoms of GPC, take your contact lenses out immediately, and schedule a visit with your optometrist or ophthalmologist to have the condition diagnosed. If you do not get treatment immediately, GPC can cause serious damage to the eye and eyelid. The condition can even scratch or damage your cornea.

While early symptoms of GPC may not seem that painful or problematic, just uncomfortable, it is important to report the signs. Severe stages of GPC include symptoms like:

  • Increased number and size of bumps.
  • Intense itching.
  • Blurry vision.
  • Mucous developing quickly and in larger amounts.
  • Movement of your contact lens around your eye when you blink.

Advanced GPC has symptoms that are nearly intolerable and can lead to damage inside the eye. These include:

  • More bumps on the underside of the eyelid.
  • Unbearable feeling of a foreign object in your eye.
  • Pain if you wear contact lenses.
  • Mucous becoming stringy or coming out in sheets.
  • Eyes sticking closed from mucous, especially upon waking up in the morning.
  • Deposits on your contact lenses.
  • Clouding on your contacts almost as soon as they are in the eye.

Giant Papillary Conjunctivitis Treatments

The first step in treating GPC is to stop wearing contact lenses until the condition clears up. Dispose of the previous contact lenses, so you do not infect or inflame your eye again.

Other steps to take during GPC treatment include:

  • Avoid wearing contact lenses for a few weeks or until the condition clears up. Wear glasses instead.
  • If you must wear contact lenses, limit how long you do so.
  • Use medicated eyedrops as prescribed by your eye doctor.
  • If you receive a prescription for eye creams or ointments to use as treatment, only use them as prescribed.
  • Change the type of contact lenses you wear. For example, switch from monthly wear to daily wear.
  • Switch contact solutions. Try an unpreserved saline solution instead of one with many different chemicals and preservatives that may cause an allergic reaction.person washing hands

If you frequently wear contact lenses to correct your vision, ensure that you follow all your doctor’s instructions on care and maintenance of the lenses and your eyes. Replace contacts as often as needed.

Some people have daily wear contact lenses, so wearing those more than one day can be detrimental. Others have month-long contact lenses, but these should still be removed every night.

Some types of contact lenses can be worn overnight because they are particularly gas-permeable. Make sure the package of contact lenses and your eye doctor state that the lenses can be worn this way.

Wash your hands before putting contacts in your eye and before you remove them. Store them with at least multipurpose solution or another type of cleansing product if that has been recommended or prescribed by your eye doctor. Change your contact lens case frequently.

If you have seasonal or frequent allergies and have struggled with GPC in the past, consider working with your physician to treat the allergy or asthma problem. This may involve prescription antihistamines, steroids, or other medications. Take these as prescribed and report any side effects to your physician if they become uncomfortable.

References

Eye Conjunctiva: Giant Papillary Conjunctivitis. (October 1, 2013). Pathology Outlines.

Giant Papillary Conjunctivitis. (2009). The Free Dictionary: Medical Dictionary.

Giant Papillary Conjunctivitis. (March 13, 2018). Healthline.

Vernal Keratoconjunctivitis. (March 11, 2019). EyeWiki, American Academy of Ophthalmology (AAO).

Atopic Keratoconjunctivitis. (November 27, 2018). EyeWiki, American Academy of Ophthalmology (AAO).

Giant Papillary Conjunctivitis. (November 30, 2018). American Academy of Ophthalmology (AAO).