Question

A patient with contact lens use since 2 years presented with the features shown in the image (giant papillae on the upper tarsal conjunctiva with increased mucus and itching). What is the most probable cause?

• A. Giant Papillary Conjunctivitis
• B. Trachoma
• C. Vernal Keratoconjunctivitis
• D. OSSN (Ocular Surface Squamous Neoplasia)

Hint:

Consider the inflammatory conjunctival complication most classically linked to prolonged contact lens wear.

Answer 1

The Correct Option is A

Step 1: Identify the clinical context.
The patient has worn contact lenses for 2 years and now presents with giant papillae in the upper tarsal conjunctiva along with increased mucus, itching, and decreased lens tolerance.

Step 2: Pathophysiology of Giant Papillary Conjunctivitis (GPC).
GPC is an immunologically mediated inflammatory condition triggered by mechanical irritation and antigenic deposits on contact lens surfaces. It occurs in both hard and soft contact lens wearers. Histology shows basophils, eosinophils, mast cells in the epithelium, and increased lymphocytes, plasma cells, and polymorphonuclear leukocytes in the stroma.

Step 3: Differentiate from other options.
Trachoma is caused by Chlamydia trachomatis and typically affects the upper tarsal conjunctiva with follicles and pannus formation but is not contact-lens associated. Vernal keratoconjunctivitis occurs in young males with an atopic background; it shows cobblestone papillae and a seasonal pattern but is not specifically related to contact lens use. OSSN presents as a fleshy gelatinous lesion at the limbus, not as papillae.

Conclusion: The correct answer is Giant Papillary Conjunctivitis.