Tear immunoglobulins in giant papillary conjunctivitis induced by contact lenses

Each of 18 patients with giant papillary conjunctivitis induced by contact lenses had symptoms of increased mucous production with blurred vision, decreased contact lens tolerance, pruritus, and giant papillae of the upper tarsal conjunctiva. When the tears were collected and analyzed for immunoglobulins, the more symptomatic eye was the left in nine patients and the right in seven patients. The fellow eyes were equally symptomatic in two patients. Tear IgE levels in patients with giant papillary conjunctivitis were significantly increased, especially in the more symptomatic eye (geometric mean, 6.9 IU/ml; P less than .01) compared with those in a control group who also wore contact lenses (2.1 IU/ml). Increased tear IgG levels (50.7 micrograms/ml; P less than .01) were found in the more symptomatic eyes of patients with giant papillary conjunctivitis. In eight of the 18 patients, tear IgM was measurable (greater than 4.7 micrograms/ml), whereas none of the control groups had detectable amounts of IgM in their tears. Studies with transferrin as a marker for the vascular leakage of serum proteins into the tears showed that local production was responsible for the increased tear immunoglobulin levels.