GIANT PAPILLARY CONJUNCTIVITIS (GPC)

GIANT PAPILLARY CONJUNCTIVITIS (GPC)
It is the inflammation of conjunctiva with formation
of very large sized papillae.
Etiology. It is a localised allergic response to a
physically rough or deposited surface (contact lens,
prosthesis, left out nylon sutures). Probably it is a
sensitivity reaction to components of the plastic
leached out by the action of tears.
Symptoms. Itching, stringy discharge and reduced
wearing time of contact lens or prosthetic shell.
Signs. Papillary hypertrophy (1 mm in diameter) of
the upper tarsal conjunctiva, similar to that seen in
palpebral form of VKC with hyperaemia are the main
signs (Fig. 4.24).
of the conjunctival and corneal epithelium to some
endogenous allergens to which they have become
sensitized. Phlyctenular conjunctivitis is of worldwide
distribution. However, its incidence is higher in
developing countries.
Etiology
It is believed to be a delayed hypersensitivity (Type
IV-cell mediated) response to endogenous microbial
proteins.
I. Causative allergens
1. Tuberculous proteins were considered,
previously, as the most common cause.
2. Staphylococcus proteins are now thought to
account for most of the cases.
3. Other allergens may be proteins of Moraxella
Axenfeld bacillius and certain parasites (worm
infestation).
II. Predisposing factors
1. Age. Peak age group is 3-15 years.
2. Sex. Incidence is higher in girls than boys.
3. Undernourishment. Disease is more common in
undernourished children.
4. Living conditions. Overcrowded and unhygienic.
5. Season. It occurs in all climates but incidence is
high in spring and summer seasons.
Pathology
1. Stage of nodule formation. In this stage there
occurs exudation and infiltration of leucocytes
into the deeper layers of conjunctiva leading to
a nodule formation. The central cells are polymorphonuclear
and peripheral cells are lymphocytes.
The neighbouring blood vessels dilate and their
endothelium proliferates.
2. Stage of ulceration. Later on necrosis occurs at
the apex of the nodule and an ulcer is formed.
Leucocytic infiltration increases with plasma cells
and mast cells.
3. Stage of granulation. Eventually floor of the
ulcer becomes covered by granulation tissue.
4. Stage of healing. Healing occurs usually with
minimal scarring.
Clinical picture
Symptoms in simple phlyctenular conjunctivitis are
few, like mild discomfort in the eye, irritation and reflex
Fig. 4.24. Giant papillary conjunctivities (GPC).
Treatment
1. The offending cause should be removed. After
discontinuation of contact lens or artificial eye or
removal of nylon sutures, the papillae resolve
over a period of one month.
2. Disodium cromoglycate is known to relieve the
symptoms and enhance the rate of resolution.
3. Steroids are not of much use in this condition.