3.7 Conjunctivitis, Contact Lens-Associated Papillary, Giant Papillary

eyes.nhs.scot/
Eyecare Guidelines/
Section 3 - Conjunctiva/
3.7 Conjunctivitis, Contact Lens-Associated Papillary, Giant Papillary

Date of last review:

29/4/2026

Date of next review:

29/4/2028

Date of publication:

6/7/2026

Differential Diagnosis ⁽¹⁾

When assessing papillary conjunctivitis, consider other allergic or inflammatory conditions:
- Vernal keratoconjunctivitis
- Atopic keratoconjunctivitis
- Seasonal allergic conjunctivitis,
- Superior limbic keratoconjunctivitis
A contact lens history is essential to help guide diagnosis.
Distinguishing Papillae from Follicles
- Follicles:
  - pale, pink/yellow, smooth, elevated lesions with lymphoid hyperplasia
  - vessels are pushed aside
  - typical of viral/chlamydial disease
- Papillae:
  - thickened irregular epithelium
  - usually more discrete and redder than follicles
  - side walls of papillae appear perpendicular to tarsal plate
  - contain vascular core visible at apex as vascular tuft

Possible management by optometrist

Advice ⁽¹⁾

Management focuses on reducing mechanical irritation and addressing contact lens–related risk factors:

Improve contact lens hygiene: better surfactant cleaning, increased enzyme use, removal of deposits.
Modify wearing schedule:
- reduce daily wear time
- stop extended wear
- temporary discontinuation of lens wear if needed
Change lens material or replacement frequency:
- use lenses with lower modulus or improved deposit resistance
- switch to daily disposable soft lenses
- replace or polish rigid lenses
Optimise lens fit: alter diameter, reduce edge clearance/thickness (rigid lenses)
Use preservative free solutions when continued soft lens wear is necessary
Ocular prostheses:
- polish, adjust, or replace where relevant

Treatment ⁽¹⁾

Topical mast cell stabilisers (e.g. sodium cromoglicate 2%)
- can be used while lens wear continues but preserved drops should not be instilled with soft lenses in situ
Combined antihistamine/mast cell stabilisers (e.g. olopatadine 0.1%) – off-label use
Use preservative free formulations (if available) whenever contact lens wear continues

In cases that do not respond to first line treatment:

Consider a 6 week course of nonpenetrating topical steroids (e.g. fluorometholone 0.1% off-label). Monitor IOP before ⁽⁷⁾ and regularly after initiating topical steroid treatment.

Typical adult dosage/duration

(Blue text = IP, black text = non-IP)

Sodium cromoglicate 2% eye drops ^(1,5)(POM): One drop ⁽⁷⁾, four times daily ^(2,3)
Olopatadine 1mg/ml eye drops ^(1,5)(POM, off-label): One drop twice daily, max duration 4 months ^(2,3)
Fluorometholone (FML) 0.1% eye drops ^(1,5)(POM, off-label): One drop ⁽⁷⁾, two to four times daily. For more serious conditions the dose can be increased to every hour for 24-48 hours, then reduce to four times daily ^(2,3). Duration will depend on severity of the condition and may require tapering ⁽⁶⁾

Regimens should be adjusted according to severity and patient factors (e.g. age, weight, pregnancy, renal function). Prescribing should follow local formulary and national guidance where available ⁽⁷⁾.

In cases of known sensitivities, please consult local formularies for alternative options ⁽⁷⁾.

Further management options

Treatment may be provided within available locally enhanced schemes, or by community IP optometrists/OMPs, as appropriate ⁽⁷⁾
Management to resolution, usually without referral ⁽¹⁾
Refer to secondary care if associated with ⁽¹⁾:
- Exposed sutures
- Extruded scleral buckle

Possible management in secondary care or local/community pathways where available

See Further management options ^(1,7)
In cases of persistent, recalcitrant CLAPC or where lens wear is medically necessary a broader range of topical steroid therapies may be employed ⁽¹⁾

College of Optometrists Clinical Management Guideline⁽¹⁾

CL-associated papillary conjunctivitis (CLAPC), giant papillary conjunctivitis (GPC) - College of Optometrists *

* With special thanks to The College of Optometrists for providing the evidence framework for diagnosis and management from the Clinical Management Guidelines (CMGs) for this condition. All references to the College/CMGs are included where appropriate and form the basis of the Community Eyecare Guidelines.

Guidance is informed by the following sources

College of Optometrists Clinical Management Guidelines Clinical Management Guidelines - College of Optometrists
Advisory alignment with the College of Optometrists Formulary Optometrists' Formulary - College of Optometrists
Advisory alignment with the BNF BNF (British National Formulary) | NICE
Advisory alignment with the Summary Product Characteristics taken from the EMC Home - electronic medicines compendium (emc)
Advisory alignment with Scottish Health Board formularies (where a clear majority is present) *
Advisory alignment with expert consensus (CEGG), informed by sources 2-5 above
Advisory alignment with expert consensus (CEGG)
“Annex C of the Statement” https://www.eyes.nhs.scot/for-professionals/legislation/

* Scottish formularies should be available within the Prescribing section of your Health Board pages on the eyes.nhs.scot website. If unavailable, contact your local Health Board for further information; Health Boards landing page

If you have a query relating to this page, please email NSS.ComEyecareGuidelineGroup@nhs.scot

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CEG disclaimer for guidelines awaiting update:

The Eyecare Guidelines area of the eyes.nhs.scot website (“Website”) is intended as a reference source for education and clinical decision support and is intended for use by ophthalmic healthcare professionals working in Scotland.

As such, the Eyecare Guidelines are not intended for use by the general public and do not replace the advice of a healthcare professional. Members of the public should seek advice directly from their optometrist.

Before reading the Eyecare Guidelines or making any management decisions based upon them, all users should read the ‘supporting information’ page which gives more detail around the content of the Guidelines and useful website links [link to Supporting Information page].

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Users should note that that the Eyecare Guidelines guidance is not mandatory. The guidelines will not be suitable for every situation and they are not intended to be a substitute for specialist expertise and clinical judgement. Users assume all responsibility for using/interpreting the information within the Eyecare Guidelines section of the website. Users should also note that the Eyecare Guidelines should not be adhered to in isolation and should be considered in conjunction with other national and locally available guidance/pathways. 

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