A 22-year-old soft contact lens wearer reports increasing mucus discharge, lens intolerance and itching over several months. Examination shows large papillae (>1 mm) on the upper tarsal conjunctiva bilaterally, with no corneal infiltrate. The MOST appropriate first step is:
- A Continue current lenses and add a topical broad-spectrum antibiotic four times daily
- B Immediate cessation of contact lens wear along with a mast cell stabiliser drop, then refit with daily disposable lenses ✓
- C Perform corneal scraping for culture and start fortified antibiotic drops hourly
- D Switch to a tighter-fitting lens to reduce lens movement across the tarsal plate
Correct answer: B. Immediate cessation of contact lens wear along with a mast cell stabiliser drop, then refit with daily disposable lenses
Explanation
Giant papillary conjunctivitis is an immune-mediated response to deposited lens material and mechanical trauma on the upper tarsal conjunctiva. Management starts with discontinuing wear, using mast cell stabilisers or antihistamine drops, improving lens hygiene and refitting, ideally with daily disposables. Antibiotics are useless since there is no infection, and scraping is reserved for suspected microbial keratitis. B tighter lens worsens mechanical stimulation rather than relieving it.
Reference: Parsons, Diseases of the Eye, 23rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.