A long-term soft contact lens wearer complains of bilateral itching, stringy mucus discharge, and lens awareness worse late in the day. Examination shows large papillae on the upper tarsal conjunctiva and coated lenses. The MOST appropriate first-line management is:

• A Oral antihistamine and continue current lenses unchanged
• B Long-term topical steroid drops with continued daily wear
• C Switch immediately to overnight extended wear with the same lens material
• D Stop lens wear, then resume with more frequent lens replacement plus a mast cell stabiliser drop ✓

Explanation

This is contact lens-induced giant papillary conjunctivitis, a type IV hypersensitivity response to deposited protein and mechanical irritation on the superior tarsal conjunctiva. Management combines interrupting wear, replacing or switching the lens (more frequent disposal, silicone hydrogel, or RGP), improving hygiene, and a mast cell stabiliser or dual-action drop. Continuing the same lenses ignores the antigenic stimulus, extended wear worsens deposits, and long-term steroids risk complications and are not first line.

Reference: Parsons' Diseases of the Eye, 23rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.