Giant papillary conjunctivitis induced by hard or soft contact lens wear: quantitative histology

Both hard and soft lens wearers develop a syndrome of decreased tolerance, increased mucus, mild itching, and giant papillary excrescences in the upper tarsal conjunctiva that resemble a varnal conjunctivitis. In the fully developed syndrome, the upper tarsal plate has an increase in stringy mucus and is covered by large papillae crowded together. The syndrome develops after months to years of otherwise successful lens wear and occurs in users of all types of soft and hard lenses. Histologic examination of tissues from 55 patients with well-developed giant papillary conjunctivitis compared with tissue from 15 normal people showed three findings characteristic of the syndrome: (1) mast cells in the epithelium, (2) eosinophils in the epithelium and substantia propria, and (3) basophils in the epithelium and substantia propria. Plasma cells and lymphocytes per cubic millimeter were not increased in detailed counts of 15 patients and 15 normal individuals. It is proposed that the number of plasma cells and lymphocytes cannot increase much beyond the level already present in normal conjuctiva and further influx of mononuclear inflammatory cells is the impetus for growth of the papillae. It is proposed that giant papillary conjunctivitis is a generalized response of the upper tarsal conjunctiva.