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The AOA’s CLCS Newsletter, February 2013
Contact lens associated giant papillary conjunctivitis
Randall McPherran, O.D.
Contact lens associated giant papillary conjunctivitis (CLPC) is a
complication primarily associated with soft contact lens (SCL) wear.1-3
With approximately 40 million people wearing contact lenses in the
United States, it is disconcerting that a recent study of 572 contact lens
patients found approximately 50 percent of the eyes suffered from at
least one contact lens-related complication.4 There was no statistically
significant difference between silicone and non-silicone SCL
complication rates, while there was a statistically significant reduction in complications with RGP
spell out at first mention, then put RGP in parenthesis lenses.4 In a different study that focused
solely on patients with CLPC, it took 5-10 times longer for CLPC development with PMMA spell
out lenses and two times longer for RGP lenses as compared to soft lenses.5
Giant papillary conjunctivitis (GPC) is associated with surface deposits on contact lenses and
ocular prosthetics, as well as with mechanically related micro-trauma (potential sources include
corneal sutures, filtration blebs and scleral buckles).5,6 While silicone hydrogel lenses have been
very useful for addressing corneal hypoxia issues, the relatively high modulus has caused an
apparent increase of CLPC as compared to standard hydrogel lenses.1 It has been noted that
while silicone hydrogel lenses have relatively less protein deposits, the deposits that are found
are mostly denatured proteins with a higher antigenic potential.1
The ultimate management goal for patients with CLPC is to enable them to comfortably remain
in contact lenses long-term. This can be accomplished in a variety of ways. As mentioned
above, switching a patient out of a silicone hydrogel material can reduce the antigen load and
decrease mechanical trauma, while abandoning soft lenses altogether in favor of RGP lenses is
another option. Other treatments include temporarily discontinuing lens wear, changing a
patient’s care system to a preservative-free solution, switching the patient into a daily
disposable lens, and/or adding steroidal or non-steroidal pharmaceutical agents.5
References:
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Sorbara, L., Jones, L., and Williams-Lyn, D. Contact lens induced papillary conjunctivitis with silicone hydrogel lenses.
Contact Lens & Anterior Eye 32 (2009) 93–96.
Zhong, Xingwu, Liu, Hongshan, Pu, Aijun, Xia, Xuefeng and Zhou, Xiaodong. M cells are involved in pathogenesis of human
contact lens-associated giant papillary conjunctivitis. Arch Immunol Ther Exp, 2007, 55, 173–177.
Zhao, Zhenjun, et al. IgE Antibody on Worn Highly Oxygen-Permeable Silicone Hydrogel Contact Lenses From Patients With
Contact Lens–Induced Papillary Conjunctivitis. Eye & Contact Lens 34(2): 117–121, 2008.
Forister, Julie F.Y., et al. Prevalence of Contact Lens-Related Complications: UCLA Contact Lens Study. Eye & Contact Lens
2009;4:176-180.
Elhers, William H., and Donshik, Peter C. Giant papillary conjunctivitis. Current Opinion in Allergy and Clinical Immunology
2008, 8:445–449.
Hodges MG, Keane-Myers AM. Classification of ocular allergy. Curr Opin Allergy Clin Immunol. 2007 Oct;7(5):424-8.
Trocme Stefan D, and Sra, Karan K. Spectrum of ocular allergy. Curr Opin Allergy Clin Immunol. 2002 Oct;2(5):423-7.
Leonardi A, De Dominicis C, Motterle L. Immunopathogenesis of ocular allergy: a schematic approach to different clinical
entities. Curr Opin Allergy Clin Immunol. 2007 Oct;7(5):429-35.
Dr. McPherran is an associate clinical professor and serves as chief of University of California
Berkeley Eye Services at Castle Family Health Center. He is a Fellow of the American
Academy of Optometry and has served as past chief examiner to the National Board of
Examiners in Optometry. He is a frequent lecturer at the American Academy of Optometry,
Ellerbrock Lecture Series.
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