Giant Papillary Conjuntivitis without Associated Triggers. Report of Two Cases

Background: Giant papillary conjunctivitis is associated with soft and rigid contact lens wearing, ocular prostheses, exposed sutures, extruded scleral buckle, filtering blebs, band keratopathy, corneal foreign bodies, limbal dermoids, and cyanoacrylate tissue adhesives. Patients present decreased lens tolerance, increased lens movement and awareness, mucus, irritation, redness, burning, and itching. Is bilateral and 10% unilateral. The upper tarsal conjunctiva shows inflammation, papules >0.3 mm, bulbar conjunctival injection, superior corneal pannus or opacities. Fluorescein noted papillary reaction. Histopathology: Mast cells, basophils  and eosinophils were found in the epithelium and substantia propia. Histamine, Ig, IgG, IgM, C3, Factor B, C3 anaphylatoxin, Eotaxin, Neutrophilic chemotactic factor are elevated in tears. Lactoferrin is decreased. Pathophysiology: The cause is unknown, factors as immunologic disease, mechanical trauma or irritation influence. Contact lenses become coated that serves as an antigen so the increased proteins in the tear film result in further coating.Treatment: Nonsteroidal anti-inflammatory agents, topical mast cell stabilizers or mast cell stabilizer-antihistamines. Replacement lenses at  2 weeks to 3 months. Daily lens disinfection with hydrogen peroxide and unpreserved saline solution.Severe should stop wearing their contact lenses for >4 weeks or refit with rigid gas-permeable lenses.

Methods: A 7 years old female presents 6 months ago redness, pruritus, forgein body sensation, eyelid inflammation without improvement with treatments. On examination with conjunctival hyperemia, hypertrophy of papillae and epiphora.

A 22 years old male presents at 7 years old conjunctival burning, foreign body sensation, conjunctival hyperemia, hyaline secretion treated with topical antibiotics and steroids with minimal and temporal improvement. On examination, conjunctival hyperemia, giant papillae on superior tarsal bilateral predominantly left. Stool negative.

Results: We found two patients affected without common triggers and early onset of severe clinical manifestations and refractory to usual treatment.

Conclusions: We present two clinical cases of unusual presentation since both of them were pediatric presentation and Giant papillary conjunctivitis has its peak of incidence in the adult population. Besides, both patients lacked an initial trigger such as contact lens wearing or ophthalmologic surgery. Both of them had a poor response to treatment. This disease should be considered in pediatric population and start treatment inmediately to avoid complications such as loss of vision.