CLAPC / GPC

Question 1

Aetiology of CLAPC

Answer 1

Inflammation of the upper tarsal conjunctiva where there is hyperaemia and roughness due to CL wear. Can also be seen in those with ocular prosthetics, protruding scleral buckles, sutures, floppy eyelid syndrome.
mechanism unknown but though to have immunological and mechanical elements.
both type 1 and type 4 hypersensitivity has been implicated.

Type 1 immediate IGE mediated hypersensitivity
- Possible antigens: altered host protein on lens surface, bacterial cell wall constituents, other lens contaminants
- reaction due to degranulation of mast cells
- degranulation allows for basophils and eosinophils to contact then conj epithelium
Type 4 delayed T cell mediated hypersensitivity
- Amplies inflammatory response.

Question 2

Predisposing Factors

Answer 2

Over wearing CLs - commonly seen in reusable, less common in dailies and rigid
EW CLs
Higher modulus CL - SiHy
Lens deposits
Poorly designed lens edge
Preservative in CL products
MGD
Atopy

Question 3

Symptoms

Answer 3

Itching and non specific irritation- burning and FB sensation worsening on lens removal (mechanical mast cell degranulation)

blurred vision, increased lens movement, decreased comfort, lens intolerance, mucus discharge

Question 4

Signs

Answer 4

Always bilateral, affecting upper tarsal conj, less likely lower

Papillae - apices stain with NaFl in active infection, whitish apices in chronic due to scarring, macro 0.3-1mm or giant >1mm, generalised (all over) or localised (one or two areas) papillae

Conjunctival hyperaemia and oedema

Stringy mucus in tear film

Question 5

Non pharmacological management

Answer 5

Reduce lens wear
- Cease for a period of time
- Abandon EW

Alter lens design
- Change to lower modulus lens
- If rigid, alter lens diameter, reduce edge clearance and edge thickness

Change to daily disposables

More frequent cleaning of lens - use enzyme products

Replace soft lenses more frequently

Polish or replace rigid lenses
Polish or replace ocular prosthetics.

Question 6

Pharmacological management

Answer 6

Topical Sodium Cromoglicate / Lodoxamide
Combined - Ketotifen / Olopatadine

If failure to respond to first line management - short course of topical FML / Loteprednol - monitor IOP at baseline, 2 week review, and then at end.

If PF, can use with CL in situ- otherwise remove lenses.

Question 7

Refer?

Answer 7

Normally no referral