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.
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