JOIN NOW

Prosthetic Contact Lens Chemistry with Giant Papillary Induced Conjunctivitis: A Case Report

by | May 1, 2023 | Manuscripts | 0 comments

Jyoti Pandit, B. Optom

Intern Optometrist, Dr. Shroff’s Charity Eye Hospital, Delhi, India

 

This blog discusses how Prosthetic Contact Lens turned out to be a necessary evil due to lack of awareness and hygiene.

Introduction

The most salient feature of Giant Papillary Conjunctivitis (GPC) is the presence of giant papillae on the upper tarsal conjunctiva. Giant papillae are arbitrarily defined as papillae with a diameter greater than 1.0 millimetres. (1) GPC likely develops from the combination of mechanical trauma to the superior tarsal conjunctiva, and it is an immunologically mediated disease. The allergic components of GPC have been under question in recent literature.

The two types of GPC are local or general. Local GPC is defined if papillae are confined to one or two areas of the upper palpebral conjunctiva and general GPC if papillae are scattered across three or more areas. (1) The average length of time patients have worn contact lenses before developing GPC is 8 months for soft contact lenses and 8 years for hard contact lenses. (1)

Case Report

A 22-year-old male patient visited our hospital complaining of ocular pain, redness, foreign body sensation and itching since the last 3 months and history of ocular trauma by wooden stick 1 year back. He presented visual acuity of NPL in Right eye and emmetrope for distance and near in Left eye. He had Prosthetic contact lens usage history in OD for 1 year and never slept with lens on. He was not using any medications nor had any allergies.

Symptoms:

The patient’s symptoms matched the common symptoms of GPC:

  • Ropy discharge
  • Severe itching after lens removal
  • Foreign Body sensation/Discomfort under the upper lid

Signs:

His left eye was fine. However, in his right eye the signs observed were:

  • Enlarged papillae
  • Rough appearance of upper tarsal conjunctiva
  • Conjunctival hyperaemia more at the superior region
  • Mild swelling around upper lids
  • Strands of mucus at inner canthus

Examination of Contact Lens:

The prosthetic contact lens was lustreless, had rough edges, severe deposits.

Figure 1: Patients affected eye showing conjunctival congestion and Prosthetic contact lens over the cornea.
(The image was captured by the author)

Figure 2: Giant papillae are seen on the tarsal surface of the inverted superior lid.
(The image was captured by the author)

Figure 3: Prosthetic Contact Lens after removal from Patient’s eye showing rough edges and deposits.
(The image was captured by the author)

Figure 4: Leucomatous opacity with 360 degrees superficial neovascularization.
(The image was captured by the author)

Differential Diagnoses

  • Allergic conjunctivitis.
  • Viral conjunctivitis.
  • Bacterial conjunctivitis.
  • Giant papillary conjunctivitis.

Diagnosis – Giant Papillary Conjunctivitis.

Treatment:

Early diagnosis is an essential part of the treatment of GPC. Patients who develop GPC secondary to their wearing contact lenses for purely cosmetic reasons could, albeit reluctantly, change from contact lenses to wearing eyeglasses. GPC patients need improvement of contact lens hygiene and replacement of lenses more often. (4)

The patient was recommended to switch to glasses from contact lens and advised lubricants, antihistamine eye ointment for 1 month and review to clinic after 1 month. Even prosthetic contact lens patients need to be on regular follow up.

The ultimate goal in managing patients with GPC is to allow patients to continue wearing their prosthetic contact lenses.

Discussion

The patient used contact lenses for his cosmetic concern. He first took the discomfort as a normal adjustment like in the first few days of lens wear, but it never got easy, and his symptoms increased day after day. Finally, he visited our hospital and hence his current diagnosis was made. He was asked to discontinue the lenses and prescribed the medications and again was instructed on lens handling, hygiene, and maintenance.

Hence, awareness regarding usage of contact lens is necessary for the common population otherwise this kind of cases will become much more prevalent in the upcoming time.

Note: All pictures are taken at Dr Shroff’s Charity Eye Hospital with informed consent from the patient for using it in any research paper.

The case report is written solely for education purposes, and it does not have any financial support and conflict of interest.

 

Reference:

  1. National Research Council (US) Working Group on Contact Lens Use Under Adverse Conditions; Ebert Flattau P, editor. Considerations in Contact Lens Use Under Adverse Conditions: Proceedings of a Symposium. Washington (DC): National Academies Press (US); 1991. Treatment of Giant Papillary Conjunctivitis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK234094/
  2. Kenny SE, Tye CB, Johnson DA, Kheirkhah A. Giant papillary conjunctivitis: A review. Ocul Surf. 2020 Jul;18(3):396-402. doi: 10.1016/j.jtos.2020.03.007. Epub 2020 Apr 24. PMID: 32339665.
  3. Donshik PC. Contact lens chemistry and giant papillary conjunctivitis. Eye Contact Lens. 2003 Jan;29(1 Suppl): S37-9; discussion S57-9, S192-4. doi: 10.1097/00140068-200301001-00011. PMID: 12772728.
  4. Raju K. Contact Lens Induced Papillary Conjunctivitis- Review and A Case Report from Nepal. J Ophthalmol 2019, 4(1): 000172.

Submit a Comment