Giant Papillary Conjunctivitis Research Articles

Recent Patents and Emerging Therapeutics in the Treatment of Allergic Conjunctivitis

Ocular allergy is an inflammatory response of the conjunctival mucosa that also affects the cornea and eyelids. Allergic conjunctivitis includes seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC) and giant papillary conjunctivitis (GPC). In general, allergic conditions involve mast cell degranulation that leads to release of inflammatory mediators and activation of enzymatic cascades generating pro-inflammatory mediators. In chronic ocular inflammatory disorders associated with mast cell activation such as VKC and AKC constant inflammatory response is observed due to predominance of inflammatory mediators such as eosinophils and Th2-generated cytokines. Antihistamines, mast-cell stabilizers, nonsteroidal anti-inflammatory agents, corticosteroids and immunomodulatory agents are commonly indicated for the treatment of acute and chronic allergic conjunctivitis. In recent years newer drug molecules have been introduced in the treatment of allergic conjunctivitis. This article reviews recent patents and emerging therapeutics in the treatment of allergic conjunctivitis.

Loteprednol Etabonate in Ocular Inflammation

Treatment of ocular inflammation imposes a major medical and economic burden. Topical corticosteroids are effective in reducing ocular inflammation but are limited by adverse events including elevation of intraocular pressure, development of cataracts, inhibition of wound healing, and increased risk for infection or viral reactivation. Loteprednol etabonate (LE) is a unique C-20 ester corticosteroid designed to produce a predictable therapeutic effect with a low incidence of side effects. Clinical trial data have demonstrated its efficacy in a variety of ocular inflammatory conditions including giant papillary conjunctivitis, seasonal allergic conjunctivitis, anterior uveitis, superficial punctate keratitis, and dry eye syndrome. These data have been corroborated by much clinical experience. Furthermore, LE may be used to reduce the inflammation associated with ocular surgery and thus improve surgical outcomes without the risks associated with traditional ketone corticosteroid use.

A Survey of Contact Lens Complications in Singapore

To describe the type of complications related to contact lens wear seen in a hospital setting in Singapore. Data were collated over a 2-year period from April 1999 to March 2001, from all public hospitals in Singapore. A standardized clinical record form was completed by the attending doctor when a patient presented for contact lens-related complications. Nine hundred and fifty-three contact lens-related complications were recorded. The mean age of presentation was 26.4 years. Women made up the majority n=491 (68%). Most patients were Chinese (555, 77%). Six hundred and seventy-six (93.7%) patients were soft contact lens wearers. Most patients, 585 patients (85.2%) wore their lenses on a daily basis. Two hundred and forty-four cases (25.6%) of infective keratitis were seen, with 55 patients requiring hospital admission for management of the infection. Soft disposable contact lens wear was associated with the majority of the infective keratitis (178, 73%). Epithelial keratitis occurred in 229 patients (24.0%) with punctuate epithelial erosions being the commonest presentation in 139 (14.6%). Allergic conjunctivitis occurred in 179 (18.8%) of the cases with giant papillary conjunctivitis accounting for 147 (15.4%) of them. Dry eyes (77, 8.1%), sterile infiltrates (71, 7.5%) and neovascularization of the cornea (75, 7.9%) were the next commonest complications seen. Corneal edema, solution- and lens-related complications occurred in small numbers, accounting for less than 5% of the complications reported. Infective keratitis secondary to soft lens wear was the most common complication, followed by epithelial keratitis and allergic conjunctivitis seen in public hospitals in Singapore.

The management of allergic eye diseases in primary eye care

Allergy is an over-reaction of the body's immune system to innocuous foreign substances or allergens that the body perceives as a potential threat or undesirable. It is estimated to affect approximately 20% of the population. Of this subset at least 20% suffer from ocular allergy. It has a significant impact on the quality of life of the individual. Allergic diseases are those conditions in which an antibody- and/or T-cell mediated mechanisms are involved. Allergic eye diseases are characterized by IgE-mast cell mediated, as seen in allergic conjunctivitis; chronic mast cell activation and eosinophil/T-lymphocyte-mediated response, as seen in giant papillary conjunctivitis, vernal keratoconjunctivitis and atopic keratoconjunctivitis; or a T-lymphocyte-mediated response in contact ocular allergy. The management of allergic eye disease is aimed at preventing the release of mediators of allergy, controlling the allergic inflammatory cascade and preventing ocular surface damage secondary to the allergic response. In the management of ocular allergic disease, the clinician is advised to recommend non-pharmacologic and pharmacologic therapeutic regimens that address the acute presentation of ocular allergy and provide prophylaxis aimed at providing long-term maintenance therapy. This approach to the management of allergic eye diseases aims to minimize the impact of the allergic reaction on the individual's quality of life. To achieve success in the management of allergic eye diseases, the clinician requires a considerable understanding of the pathophysiology, clinical features and differential diagnosis of the different types of ocular allergy, as well as an adequate knowledge of their pharmacotherapy.

Prevalence of Contact Lens-Related Complications: UCLA Contact Lens Study

This study is a cross-sectional analysis of the types and prevalence of contact lens (CL)-related complications among CL wearing patients seen in a university clinic setting. Data on CL material and design, care system, and ocular complications were recorded and statistically analyzed for CL wearers. Of the 572 patients (846 eyes) recruited during the study, approximately 50% of the eyes had at least one CL-related complication. Rigid gas permeable (GP) CLs had a statistically lower (P<0.01) average number of complications (0.54 +/- 0.68) than soft contact lenses (SCLs) (0.85 +/- 0.82). Papillae and giant papillary conjunctivitis were the most prevalent complications in both GP and SCL wearers. Silicone SCLs (0.79 +/- 0.76) had a slightly lower, although not statistically different (P=0.23), rate of complication than nonsilicone SCLs (0.90 +/- 0.87). Although not statistically significant (P=0.29), extended wear CL use had a higher complication rate (0.93 +/- 0.84) compared with daily wear (0.73 +/- 0.79). Use of "other" solution, including generic and private label solutions, had the highest rate of complications for both SCLs (1.11 +/- 1.27) and GPs (0.96 +/- 0.93) compared with name brand solutions. The prevalence of CL-related complications, regardless of lens design, material, and wear modality, highlights the importance of early detection with appropriate professional management and treatment.

Use of tissue adhesives in ophthalmology

Use of tissue adhesives in ophthalmology

Lentes de contato terapêuticas e as vantagens dos materiais de alto Dk

Therapeutic contact lenses are useful in a variety of ocular surface diseases. Their main indications are: to relieve the pain; protect ocular surface; promote corneal healing and epithelial regeneration; seal a leaking corneal wound and deliver ophthalmic drugs on the ocular surface. There are several kinds of lens designs and materials, and their choice is dependent on the specific disease to be treated, the duration of treatment and the physiologic needs of the diseased cornea. Bullous keratopathy, recurrent epithelial erosion syndrome, dry eye and postoperative epithelial defects are amongst their indications. Therapeutic contact lenses should not be indicated in the presence of active infectious keratitis or when the patient is not compliant. Corneal neovascularization, giant papillary conjunctivitis and infectious keratitis are serious complications, which can be prevented by correctly fitting and maintaining the therapeutic contact lenses. Silicon-hydrogel therapeutic contact lenses, due to their higher oxygen permeability, allow extended wear schedules, decreasing the need for frequent lens replacement.

Giant papillary conjunctivitis

Despite shorter replacement intervals and new lens materials, giant papillary conjunctivitis still limits the ability of some patients to wear contact lenses. Recent research has elucidated many new mediators of inflammation. The presence of chemokines and cytokines such as IL-8, IL-6, IL-11, macrophage inflammatory protein-delta, tissue inhibitor of metalloproteinases-2 macrophage-colony stimulating factor and monokine-induced gamma interferon, eotaxin, pulmonary and activation-regulated CC chemokines have been shown to be elevated in patients with giant papillary conjunctivitis. In addition, M cells and B lymphocytes have been hypothesized to play a role in the pathogenesis of giant papillary conjunctivitis. The pathophysiology of giant papillary conjunctivitis is complicated with both immune and mechanical mechanisms playing a role in the development of this condition; understanding these mechanisms is important in both treatment and prevention of giant papillary conjunctivitis.

Use of Sealant (HFG) in Corneal Perforations

To repair corneal perforation using human fibrin glue and determine its efficacy. A case series study was performed on corneal perforations up to 3 mm in diameter who were admitted in Farabi Eye Hospital. Age, visual acuity, presence and size of corneal thinning, corneal epithelial defect, size and depth of corneal infiltration, site and size of corneal perforation, corneal vascularization, anterior chamber depth, and reaction and the etiology of corneal perforation were recorded. Then, corneal perforation was sealed using FG and soft contact lens, and the patients were followed up for at least 3 months. Healing of the corneal perforation with adhesive was considered as a success (the primary outcome) and reported. Of 18 patients, 8 were women and 10 men. The mean age of the patients was 52 +/- 25.7 years. The size of corneal perforations was 0.6-3 mm (mean = 1.88 mm). The etiologies of corneal perforation were postinfectious in 11 and noninfectious in 7. Fifteen (83.3%) eyes had successful healing of corneal perforation after 3 months. All the patients who were failed had corneal perforation larger than 2 mm in diameter. The success rate was higher in corneal perforation <or=2 mm in diameter. No case developed giant papillary conjunctivitis or secondary glaucoma. Only 1 (5.6%) eye showed a significant increase in deep corneal vascularization. FG is effective in the closure of corneal perforations up to 2 mm in diameter. Corneal perforation larger than 2 mm may not respond well. It provides fast healing with low rate of corneal vascularization.

Measurement of IL-4 in tears of patients with seasonal allergic conjunctivitis and vernal keratoconjunctivitis.

To elucidate the mechanism of ocular surface allergic disease, we focused on IL-4, which is one of the key factors in regulating IgE production, and thus determined the concentration of IL-4 in tears. IL-4 concentration was determined in the tears of 15 patients with seasonal allergic conjunctivitis, 15 vernal keratoconjunctivitis (VKC), 10 giant papillary conjunctivitis (GPC), 10 patients with non-allergic conjunctivitis and post-cataract surgical conjunctivitis as intermediate conjunctivitis, and 10 normal subjects using a highly sensitive sandwich ELISA. The mean level of IL-4 in normal controls was low, and seasonal allergic conjunctivitis, VKC and GPC showed a significant elevation (P < 0.05), respectively. IL-4 of VKC and GPC were also significantly higher than allergic conjunctivitis, and non-allergic conjunctivitis and post-cataract surgical conjunctivitis were not higher than normal. These results raise the possibility that the increased level of IL-4 in tears could play a role in allergic disease and its severity in patients.

Long-Term Results of a Suture Burial Technique

To report the long-term (minimum 24 months of follow-up) results of a scleral suture fixation technique. Surgical databases from one surgeon were reviewed for consecutive cases from March 2003 to August 2005 in which the scleral suture fixation technique was used and a minimum follow-up of 24 months was completed. In this study, by knotting the suture onto itself, the author has buried the end and the knot of the suture into the sclera for scleral fixation, to stay put within the sclera. Intraoperative technical complications, postoperative visual outcomes, intraocular pressures, and suture-related complications were evaluated for each patient. A total of 150 scleral-sutured free suture ends were evaluated after a minimum 24 months of follow-up in 75 eyes of 75 patients. No technical or suture-related complications (suture exposure, irritation, granulomas, giant papillary conjunctivitis, suture abscess) were recorded throughout the follow-up period. Long-term follow-up of the suture burial technique - which allows avoidance of scleral incision, flap, or tunnel formation, as well as patch grafts for scleral fixation of intraocular lenses - showed it to be safe and effective.

Tacrolimus Ointment 0.03% in the Eye for Treatment of Giant Papillary Conjunctivitis

To report a case of refractory giant papillary conjunctivitis (GPC) treated by using topical tacrolimus 0.03% ointment. A 16-year-old white boy with a history of GPC was referred to our department for severe GPC with eye itching, tearing, photophobia, discharge, and blepharospasm. The patient had received previous treatments with antihistamines, mast cell stabilizers, topical corticosteroid ointments, and surgical resection-cryopexy of GPC that were ineffective. Topical tacrolimus 0.03% ointment (Protopic; 0.5 cm) was applied into the lower fornix twice a day. An improvement of the patient's symptoms was observed during the first 5 days of therapy, and the GPC was resolved within 15 days. After 1 month of continued topical tacrolimus ointment treatment, there was no evidence of GPC. Topical tacrolimus was tapered during the next 2 months. Six months after treatment, there were no GPC findings, and no side effects were reported. Topical tacrolimus 0.03% ointment for severe GPC, refractory to conventional therapy, appears to be an effective alternative treatment.

Treatment of ocular inflammatory conditions with loteprednol etabonate

Ocular inflammatory diseases impose a significant medical and economic burden on society. Corticosteroids are potent anti-inflammatory agents that have been used successfully to treat ocular inflammation. Topical corticosteroids provide maximal...

Unilateral Vernal Keratoconjunctivitis: A Case Report

A rare case of unilateral vernal keratoconjunctivitis is presented. A 5-year-old boy had itching, foreign body sensation, redness, and ptosis in his left eye. Impression cytology specimens were taken from both upper eyelid tarsal conjunctiva. On slit-lamp biomicroscopy, unilateral cobblestone papillae and a shield ulcer were found in the left eye. On impression cytology examination, there was a significant increase in inflammation, presence of a honeycomb pattern, plasma cells, and mucus strands in the upper tarsal conjunctiva of the specimens. Giant papillary conjunctivitis must be considered in differential diagnosis of unilateral vernal conjunctivitis. Impression cytology method may be combined with the clinical findings in vernal keratoconjunctivitis diagnosis.

Filtering bleb-induced giant papillary conjunctivitis

Pathogenesis of giant papillary conjunctivitis is still elusive and many hypotheses are being proposed to explain the irritative symptoms associated with it. The research data available to date shows that mechanical, immunological and allergic components are involved in this to various extents. We report a rare cause of giant papillary conjunctivitis which was induced by a large filtering bleb following trabeculectomy surgery for glaucoma. A 30-year-old female, operated for glaucoma filtering surgery in her right eye 15 years back, presented with ocular irritation. Clinical evaluation revealed two giant papillae on the superior tarsal conjunctiva which coincided with the large filtering bleb with its peripheral extension. The fellow eye was normal and no association with any allergic disorders was noted. The patient responded symptomatically to the topical application of anti-inflammatory and anti-allergic medications. The giant papillae decreased considerably in size but the diffuse papillary response persisted. Though multiple etiological factors have been proposed for the giant papillary conjunctivitis, only a single case report is available where a filtering bleb is the causative factor. The mechanical irritation caused by the large-sized bleb seems to be the provoking agent in our case taking into consideration the position of the papillae that coincides with the peripheral extension of the bleb.

Concentration of Soluble Interleukin-6 Receptors in Tears of Allergic Conjunctival Disease Patients

To evaluate the significance of soluble interleukin-6 receptor (sIL-6R) in tears as a clinical indicator of disease exacerbation in patients with allergic conjunctivitis disease (ACD). The study groups comprised 13 patients (13 eyes) with vernal keratoconjunctivitis (VKC group), 13 patients (13 eyes) with atopic keratoconjunctivitis (AKC group), 11 patients (11 eyes) with giant papillary conjunctivitis (GPC group), and 10 healthy volunteers (10 eyes) as a control. Tear samples were collected by the Schirmer I method using filter paper. Tear samples were eluted and the concentration of sIL-6R in tear samples was determined by enzyme-linked immunosorbent assay. Impression cytology using a nitrocellulose membrane was applied to the upper tarsal conjunctiva, and the mRNA of the signal-transducing molecule glycoprotein 130 (gp130) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) was extracted from the membrane and analyzed by semiquantitative reverse transcription-polymerase chain reaction. In the VKC group, the clinical score was graded on the basis of allergic inflammation of the ocular surface, and the correlation between the concentration of sIL-6R and the clinical score was studied. The concentration of sIL-6R in tears in the VKC, AKC, GPC, and control groups was 5.1 +/- 4.7, 1.2 +/- 1.7, 2.6 +/- 2.8, and 0.5 +/- 4.3 (mean +/- SD) ng/ml, respectively. The concentrations of sIL-6R in tears in the VKC and GPC groups were significantly higher than those in the control group (P < 0.001 and 0.05, respectively). The AKC group showed no significant change in the concentration of sIL-6R in tears in comparison with the control group. The gp130/GAPDH mRNA ratio was significantly higher in the patients with ACD than in control individuals (P < 0.05). The concentration of sIL-6R in tears and the clinical score of allergic inflammation of the ocular surface were significantly correlated in the VKC group (r = 0.53, P < 0.01). We concluded that IL-6/sIL-6R complex trans-signaling via gp130 is an exacerbating factor of ACD, and that the concentration of sIL-6R in tears is a useful clinical biomarker in patients with ACD.

Immunohistochemical findings in prosthesis‐associated giant papillary conjunctivitis

To identify functional subsets of inflammatory cells and expression of cytokines in the conjunctiva of patients with ocular prosthesis-associated giant papillary conjunctivitis (P-GPC). Specific immunohistochemical staining using monoclonal antibodies was performed on biopsy specimens obtained from superior tarsal conjunctiva of 18 patients with P-GPC. The prosthetic eyes were taken as the study group, whereas their fellow eyes were used as matched controls. In normal conjunctiva, mast cells (MCs) were located only in the substantia propria (SP), whereas in P-GPC eyes MCs were also notable in the epithelium in five specimens. Tryptase-chymase-positive MCs (MC(TC)) were predominant both in P-GPC (79%) and in fellow (72%) eyes. MC(TC), CD4(+) lymphocyte, CD8(+) lymphocyte and eosinophil numbers were higher in P-GPC specimens compared with the fellow eyes (P = 0.005, 0.074, 0.012 and 0.025, respectively). Eosinophils were detected in 58.8% of P-GPC specimens and 16.7% of control specimens (P = 0.053). The number of inflammatory cells expressing eotaxin and interleukin (IL)-4 was higher in P-GPC group (P = 0.050 and 0.048, respectively). Nine out of 17 giant papillary conjunctivitis specimens (52.9%) showed eotaxin and IL-4 immunoreactivity, which was considerably higher than the fellow eyes (16.7%) (P = 0.064). These findings suggest that P-GPC is an allergic disease of the eye associated with increased numbers of MC, eosinophils and lymphocytes in the conjunctiva and a remarkable expression of IL-4 and eotaxin both by the conjunctival epithelium and by the inflammatory cells in the SP.

M cells are involved in pathogenesis of human contact lens-associated giant papillary conjunctivitis

.Introduction:The objective was to study the pathogenesis of contact lens-associated giant papillary conjunctivitis (CL-GPC).Materials and Methods:Twenty-one biopsies of conjunctival giant papillae were obtained from soft contact lens wearers. The tissues were fixed in 4% paraformaldehyde and embedded in paraffin. Sections of 5 µm thickness were used for studies of histology and immunohistochemistry of pan-B and pan-T cell distributions.Results:Conjunctival epitheliums on the top of conjunctiva-associated lymphoid tissue typically lacked goblet cells. Lymphocytes from underlying lymphoid follicle were pressed into intra-epithelial “pockets” formed through epithelial invagination. Under the follicle-associated epithelium, pan-B cells were mostly gathered in the central folliclar area and intraepithelial pockets, while CD3-positive T cells were predominantly distributed in parafolliclar region, but only a few in the intraepithelial pockets.Conclusions:Membranous epithelial cells (M cells) play a key role in the pathogenesis of CL-GPC for the binding and translocation of antigen and pathogen.

Reactive Lymphoid Hyperplasia of the Nasolacrimal Duct Presenting as Bloody Epiphora

A 90-year-old man reported a 1-year history of tearing and irritation in the left eye. Ophthalmic examination was significant for bloody mucopurulent material expressed from the left nasolacrimal duct. The patient underwent external dacryocystorhinostomy with excision of a soft-tissue mass. Initial histopathologic examination of the specimen revealed an atypical lymphoid infiltrate. Subsequent immunohistochemistry suggested that the mass was reactive lymphoid hyperplasia. Lymphoid hyperplasia should be considered in the differential diagnosis of bloody epiphora, in addition to primary malignancy of the nasolacrimal duct, hematologic abnormalities, coagulopathies, vascular tumors, and giant papillary conjunctivitis.

A Retrospective Case Series: Use of SoftPerm Contact Lenses in Patients With Keratoconus

To evaluate the performance of the SoftPerm contact lens in patients with irregular astigmatism caused by keratoconus. Twenty-four eyes of 14 patients with keratoconus who had intolerance to rigid gas-permeable contact lenses and were fitted with SoftPerm lenses at Kartal Training and Research Hospital between August 1998 and January 2002 were evaluated retrospectively. The average follow-up time was 23 months. Patients were between the ages of 16 and 39 years. All patients were examined by corneal topography before a SoftPerm contact lens trial. A standard protocol was used to select the initial trial lens on the basis of computer-generated topographic keratometric readings. Final lens selection was based on clinical performance. Visual acuity and complications were analyzed after fitting. Best-corrected spectacle visual acuity of 20/40 or better was noted in 12.5% of eyes before the SoftPerm contact lens trial and increased to 83.3% after the SoftPerm contact lens fitting. Lens damage especially related to separation at the junction was observed in 29.1% of patients, discomfort in 29.1%, giant papillary conjunctivitis in 25%, and peripheral corneal neovascularization in 25%. Discomfort was the most common reason for discontinuation. SoftPerm lenses can be considered when high astigmatism is encountered in patients with keratoconus who have better visual acuity with SoftPerm lenses than with spectacles and who are intolerant of rigid gas-permeable lenses.