Which of the following is NOT a typical mechanism by which contact lens wear contributes to GPC?

• A. Hypoxia
• B. Mechanical friction
• C. Immune response to lens proteins
• D. Disinsertion of the levator

Answer: (D)

Giant papillary conjunctivitis from contact lens wear arises mainly from three processes: chronic mechanical irritation from the lens rubbing against the palpebral and bulbar conjunctiva, hypoxic stress due to limited oxygen transmission, and an immune reaction to proteins deposited on the lens surface. These lead to inflammatory papillae on the upper eyelid conjunctiva.

Disinsertion of the levator is not a mechanism by which contact lens wear causes GPC. Levator disinsertion is an eyelid muscle problem that would affect lid position (ptosis) and lid movement, not the conjunctival inflammatory papillary response characteristic of GPC.

The other mechanisms fit well: mechanical friction from the lens edge drives irritation and papilla formation; hypoxia can promote inflammatory changes; and immune responses to deposited lens proteins can provoke an allergic-type reaction with giant papillae.