GPC

GIANT PAPILLARY CONUNCTIVITIS aka "GPC"
One of the most common things I diagnose and one of the most asked questions on Yahoo Answers is about GPC. GPC is a contact lens-induced inflammatory event where "bumps" (or papules) form on the backside of the eyelid. It is not dangerous nor sight-threatening, but it is certainly annoying. GPC causes red, itchy, sometimes painful eyes, and a feeling of "foreign body sensation", especially with the contacts in. It can also cause some significant blurry vision, b/c the papules can move or drag the lens around. This lens movement is especially bothersome to toric wearers, where contact lens orientation is paramount for good vision. GPC is usually caused/exacerbated by:

seasonal allergies

heavy contact lens wear

mechanical "lid interaction" between the edge of the contact lens and the back of the eyelid

lens modulus or stiffness

lack of contact lens schedule compliance (wearing the same pair for too long, sleeping in them, not cleaning them well or using the wrong solution to store them in, etc etc)

Multiple different theories exist on how to treat GPC. The most conservative route is to just permanently discontinue contact lens wear. Lots of docs tell patients they just can't wear contacts anymore. Lens discontinuation certainly works, but patients generally don't like this plan much, for obvious reasons. The following are my opinions on how to treat most cases of GPC w/o permanent lens wear discontinuation:

All moderate-to-severe cases probably need to stop wearing contacts for some amount of time. A few weeks at least, with severe cases being a few months. During that time I treat the "bumps" with topical steroids (lotemax, alrex, etc) and topical antihistamines (patanol, optivar, alaway, etc). In severe cases I also recommend oral antihistamines like claritin.

Once the inflammation finally starts looking/feeling better, I allow the patient to gingerly resume contact lens wear for short periods. I also really think it works well to switch patients to daily disposable contact lenses. The reasons being that dailies are very thin with a thin edge and low modulus (floppy), and have exactly zero chance of buildup. Buildup and stiff lenses are 2 of the notorious exacerbators of GPC IMO, and both can quickly be solved with a switch to dailies. Of course not all Rx's are available in dailies, so if I can't do dailies I'll recommend a hydrogen-peroxide based cleaning solution like CLEAR CARE by CIBA.

Problems arise when patients can't or won't do everything I tell them. Switching to dailies is expensive. Using clear care is tedious, especially if you're used to no-rub chemical solutions like Renu. Discontinuation of lens wear for months at a time is undesirable, and for some patients just downright impossible. Patients who are non-compliant with their wear/care schedules generally go back to being non-compliant at some point. And sometimes even when the patient does everything right, some patients just never truly get completely over it. But with the right treatment and a motivated patient who doesn't mind spending some extra money (to switch to dailies) and some extra time/effort (for follow-up appointments and eyedrop schedules), most GPC cases can be treated successfully, and most patients can eventually comfortably wear contacts again.

Comments

  1. Thank you, for the great write up.

    I'm assuming that its a problem that never goes away?

    Is the only permanent solution vision correction?

    Which procedure would you recommend if so?

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  2. no, some GPC goes away after treatment. some doesnt. IF it doesnt go away, yes LASIK works really well.

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  3. Hello. I was just diagnosed with GPC today. I am not surprised given my past history of wearing my contacts in college. (Being the poor "starving" college student I would try to maximize the life span of my 'one year' contacts as long as possible.)
    I was given a prescription of patanol eye drops, and will be using Muro eye ointment at night. I am back to my glasses. It's not exactly ideal since I'm a skier, runner and swimmer- but I want this to heal! I pray for a speedy recovery. I have been putting off LASIK, but will look into it. Do I have to be completly cured of this before I have this operation?
    Thank you for this information you have provided!
    Kim

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  4. every surgeon is a bit different, and i am not a sirgeon. BUT: IMO i do not think your gpc must be totally resolved before you have lasik. the only real requirements are:

    1) healthy cornea that hasnt had contacts on it for a full month prior to taking the measurements for lasik

    and

    2) Rx within parameters of lasik

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  5. Thank you so much for your help on Yahoo and on here. I found the info about the toric wearers interesting. I have been diagnosed with astigmatism, so I have to wear toric lenses. After reading all this info, I plan on seeing my eye doctor asap. I was glad to read that you are a Christian also. :)
    thanks again for your help!
    Laurie

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  6. if you were cruising along just fine & never had a problem before & suddenly now one or both of them move around when you blink...and they're not inside out & they're the same contact lens you've always had etc etc

    then its GPC.

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  7. I was diagnosed with gpc about two weeks ago and my eyes are still red and get worse through the day. Is there anything I can do to speed up the process I am already taking pataday once a day and steriods twice a day. I am getting married in a month and I'm afriad I will still have red eyes :(

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  8. not really much you can do besides what you're already doing: steroids, antihistamines, stop wearing contacts, no "rubbing" your eyes, etc. i think you'll probably be fine at your wedding. i'd sure ask for DAILIES tho when you do resume contact lens wear

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  9. Ok thank you. I guess I was just hoping the redness would go away as soon as I stopped the contacts but I've been told it takes time. I already ordered the dailies. It's just frustrating because the symptoms started 2 months ago and I saw 2 different supposed eye Dr's who kept telling me I had seasonal allergies and I could wear my contacts. I finally made an appointment with an actual ophthalmologist who said I had GPC when she flipped my eyelid. I never even heard of GPC before now. Your blog was very helpful, thank you so much!

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  10. yeah unfortunately a bunch of eye doctors miss it, even ophthalmologists.

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  11. sorry one other question I forgot, I am using lotemax twice a day for one week and when I use the lotemax it initially turns my eyes more red, is that normal?

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  12. update....So I went to my Dr. for a follow up today and she said the lotemax is helping with the gpc but causing me to have dry eye so she wants me to stop it and just use artificial tears and allergy drops...hope it works...I'm tired of the ugly red eyes

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  13. Your article was very helpful. I started having problems with my eyes this year and went to my eye doctor 5+ times and was never given a clear answer. He changed contacts, solutions, gave me allergy drops and nothing worked. I finally went to a different doctor and he diagnosed me with GPC. I am now taking Lotemax for several weeks and hope to get back into daily contacts after a while. It's nice to have a name for it though and not just an "I have no idea" look.

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  14. Thanks for your blog... pretty useful to the point information.

    I have a question though if you don't mind.

    I have mild GPC. Since May, for the most part, I have been wearing daily contact lenses. I have used and am currently using Patanol eye drops, but did go on Alrex for 2 weeks. Since the beginning of July I have limited my contact lens wear to strictly during baseball games (which is still 6-7 hours a day once you factor in BP and driving to games 6-7 times a week, not to mention double headers). I have the next 3 - 4 weeks off from baseball but will be going to play college ball in the fall and really want to be able to wear contacts comfortably. If I do not wear my lenses at all for this period of time and use my patanol drops, should my gpc clear up? To this point I have noticed very slight changes (I think due to the fact I am still wearing my daily lenses all day every day).

    Thanks,

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  15. don't know if YOUR GPC will clear up or not in that amount of time, but I would say its statistically MUCH MORE PROBABLE to clear up when NOT wearing lenses vs that time spent wearing lenses. so yeah, skipping that time is a great idea IMO if possible

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  16. Thanks for the answer... your blog is awesome btw I never knew all this contact lens stuff would interest me so much...

    if you don't mind me asking I have another question... my daily contacts are made by CIBA (Focus Dailies Toric) however they do not match my astigmatism exactly. The sphere is correct but instead of an right / left cylinder of 1.75 / 1.25 I am wearing a 1.50 / 1.50 (as this is all the dailies come in). Should this slight difference in cylinder affect me while playing baseball? I don't really notice a difference while looking at your typical eye chart, but as far as depth perception and tracking a baseball, would the slight difference affect me at all?

    Thanks again,

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  17. if you're "really" -1.25 & -1.75 cylinder (astigmatism) and your doc Rx'd dailies of -1.50 & -1.50...thats certainly close enough IMO. not only did you not notice the difference, but *MOST* wouldn't

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  18. I spent the last week and a half without wearing contacts and using my patanol. Today I put in my contacts for two hours to go hit some balls with my friend... My eyes felt a little better but still they were not great, near the end of the two hours I felt like I needed to pull them out. I have been doing a lot of reading on gpc and have heard that silicone hydrogel contact lens are generally worse for people with GPC because they are generally stiffer (with some exceptions). I right now when I wear lenses am wearing Focus Dailies Toric. Is this lens silicone hydrogel / is it a pretty good lens to treat GPC (floppy and low chance of buildup)? I am asking this because I am pretty sure it is going to take longer than three weeks to get rid of this GPC and thus am going to NEED to wear lenses during baseball in the fall and want to wear the best lenses possible.

    Thanks again for all the help.

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  19. And also, is there a difference between GPC and CLPC. I have been told I have GPC sometimes and sometimes I have been told I have CLPC. Are they not the same thing?

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  20. yes GPC & CLPC are the same thing. giant papillary conjunctivitis vs contact lens-induced papillary conjunctivitis.

    focus dailies toric is not silicone, however its still pretty stiff b/c its a dual thin zone design toric. unavoidable if you have astigmatism.

    if you were my patient I'd have you on more & stronger steroids. Lotemax. Patanol is nice in *very mild* or fleeting cases, but for people who are really suffering its a drop in the bucket

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  21. I would def ask for some type of steroid eye drop if your are suffering. I have been dealing with GPC for the past 2 months. The first month I spent going from Dr. to DR. with red itchy eyes and was told time and time again I was having allergies. After going to an allergist and determining I didn't have allergies I went to another Dr. who diagnosed me wtih GPC. She did the same thing to be which was tell me to hang in there and gave me pataday. I was miserable and went back and was given lotemax this helped the bumps but dried my eyes out alot. So I was switched to Fluoremethlone wich is a more mild steriod. My eyes are still a little red in certian spots but not as terrible as they were. I have a follow up next week to see how I'm doing. My friend had it and it took her 3 months for her eyes to clear up and she was usuing rewetting drops for awhile to help with the dryness. Hope this helps someone :)

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  22. Just diagnosed with GPC today and am planning to wear glasses until my ophthalmologist tells me otherwise. However, my vision is still heavily blurred in one eye, even while wearing glasses. Will the blurriness subside as the GPC heals?

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  23. generally GPC doesnt cause too much blur once the lenses are out. so, dont have a great answer as to when your blur will subside.

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  24. I stayed out of my lenses for 3 weeks in the end of august while using patanol. Put my lenses in and there was not much of a difference. So I went to the optometrist and was given lotemax. Used lotemax for slightly over a month during baseball season while wearing my contacts 3x a week for 3 - 5 hours at a time (dailies). I had no choice. Saw no real drastic improvement during this period. I had to stop lotemax because potential risks involved with long term steroid use and am now using just patanol again. I have been wearing my contacts one time per week for a couple hours at a time (I have been doing for a month now). I am going to look into ortho-k as its clear my gpc is going to be a tough one to fight. I have a few questions for you...

    Does my prescription fit into the range of ortho k (3.00 1.50 110 and 3.50 1.50 70)?

    Are there any alternatives if ortho-k doesn't work for me. I play college baseball and need to not have glasses and wearing contacts with gpc affects vision and thus preformance greatly. I am only 19 years old so I am worried about lasik; however, at this point, having gpc for almost a year now I don't know many other options.

    I right now wear my lenses when I go out on saturday nights. Would it significantly speed up recovery if I didn't wear my lenses at all. Would the couple hours I wear them (a daily disposable lens) on saturday nights really slow down my recovery by significantly?

    Thanks again for all the help

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  25. ok a few things:

    torics are rough. even dailies toric. now we know why your gpc is so "bad". torics are thick & stiff.

    if your gpc really is that bad, patanol is a drop in the bucket. IMO you're probably wasting your time with patanol alone.

    IMO the "long-term risks of steroid use" are minimal with lotemax. dexamethasone? yes. prednisolone? certainly. but loteprednol? meh. i aint skeered (as they say :D ).

    ortho-k isnt going to work very well with those axes. you'll be left with a diopter or so of oblique cyl, which is probably not good enough for most people.

    lasik is probably your best option. there isnt an easy fix here. cant go to nice floppy dailies b/c of the cyl & need for torics, cant do ortho-k b/c of the cyl axes. if you were my patient 'd put you back on lotemax or send you for lasik. even if you are 19. are you getting progressively worse myopia? if your Rx is stable i'd be giving it serious consideration. no "other alternatves". contacts, lasik, ortho-k. thats it.

    "Would the couple hours I wear them (a daily disposable lens) on saturday nights really slow down my recovery by significantly?"

    nope. not IMO.

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  26. Thank you for your write up on this. I was unfortunately diagnose with this back in November. I was told to go three weeks without contacts, using steroid drops for two of those weeks. I started back using my contacts after the third week but began having problems again about a week later. Now I'm back to glasses and have been back to the eye doctor who told me to do the same thing; another three weeks.
    I first noticed a foreign body sensation in my eye in June but did not go to the doctor until November. In your opinion, do you think mine didn't heal the first time because it just wasn't long enough? If it had been building from June to November, maybe it just hasn't been long enough for my eyes to heal.
    I am seriously hoping this goes away because I cannot stand glasses, but I have been following the doctor's orders.
    Also, I cannot afford daily lenses in my brand (Acuvue advance). However I have found a brand I can afford. It is called SofLens. Do you know anything about this brand?

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  27. yes bausch & lomb's soflens 1-day. its a good product. IMO dailies are the way to go with GPC. i personally usually use ciba dailies but b+l soflens 1-day is comparable.

    as for how long GPC takes to "heal"...it varies. some people never get over it. some people always have it but with dailies its "subthreshold" (small enough bumps so that the patient doesn't feel it).

    getting out of silicone contacts IMO really helps. i fit a lot of silicone...its my 1st choice material for most patients. but for known GPC sufferers, i personally think silicone exacerbates it. so if you switch to a daily, i wouldnt do "trueye"...thats a silicone daily.

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  28. Alright, back again to ask another question (I posted in November and in the summer regarding my gpc, toric lenses, etc.). It has kinda come to the point where I've kind of given up hope with contact lenses. I am back on Lotemax, as well as opticrom, patanol, and zaditor. I am putting in drops around 8 times a day (4x lotemax, 4x opticrom plus 3x zaditor and 2x patanol). Baseball season is right around the corner and although my eyes have gotten better, they aren't back to what they used to be and the progress has been so slow considering I've essentially been without lenses for 3.5 months now that I am beginning to look into Lasik.

    What is your opinion regarding Lasik eye surgery. As I said before, I play competitive college baseball so eyesight is crucial to my preformance. I tried to get in contact with a nationally recognized lasik surgeon where I go to school but was told he does not do surgery on anyone under 21, which only added to my fear of the surgery. I mean, this is only eyesight right?

    Anyway, got in touch with another surgeon back home, he's well respected, costs a fair amount but I am willing to pay whatever as long as I get it done right. I have a break from baseball for the month of May, and am seriously considering the surgery. I will be 19, my prescription has not changed more than a quarter power in the past 2 years, and all signs point to me getting the surgery.

    Now I know the surgery is generally safe, Eric Hosmer a 19 year old prospect with the Royals had it done as well as a number of other baseball players, but this is my vision so I want to gather as much information as possible. I just wanted to ask you what your thoughts were on the procedure, as there is so much conflicting information in the media (what with that former FDA guy coming out and saying it was a terrible decision to approve corrective surgery's etc.). I have heard success rates as high as 98% to as low as 55%, with failures resulting from extreme dry eyes, not 20/40 vision, etc (obviously as a baseball player I would hope to get 20/20 or better, I am 20/15 with contacts now but that doesn't help much when there constantly moving when I blink). I've heard the most important thing you can do is get the best surgeon who uses the best equipment. This is why when I contacted the head corrective surgeon at one of the top 5 opthomology hospitals in the states and he said he only does it on patients 21 or older, I became a bit worried.

    Thanks again for all the help and for reading and responding to all my long winding posts...

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  29. i had lasik in march of '07. i blogged about it here:

    http://myeyepod.blogspot.com/2009/06/my-lasik.html

    that blog entry was from march of '07. i realize the date of that entry is june of '09, but my blog was ported over from yahoo360 when yahoo stopped hosting blogs, so it was "re-posted" on this blogspot site in june of '09, but the original entry is march of '07.

    anyway i personally am a fan of lasik. here's who is great for lasik:

    - young people under 35
    - nearsighted with or w/o astigmatism
    - stable Rx
    - thick cornea

    here's who i won't send for lasik anymore:

    - hyperopes (farsighted)
    - presbyopes (over 40)
    - high Rx (IMO over about -8.00 or so)
    - thin corneas
    - unstable
    - big pupils
    - dry eye
    - any eye disease

    i personally am not scared of sending a 19 year old for lasik. i did so (sent a 19 year old for lasik) about 6 weeks ago, actually. don't be too scared of the FDA's recent "warnings". a LOT of those problem patients are people who should have never had lasik in the 1st place. IMO most of them were bad candidates who were dying to have lasik & found a not-very-conservative surgeon to do it. but man if you're doing eyedrops 8x/day so you can try to wear contacts & you're still failing...thats not normal. that certainly makes a case for thinking about lasik. i think its at least worth investigating. i personally wouldn't be scared at all of this kind of case...as long as the Rx isn't too high, the corneas are thick enough, the Rx is stable, etc etc etc. IMO age (as long as you're over 18 & under 35) isn't too much of a factor

    good luck!

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  30. Hello Doctor,
    I am hoping you can share some insight to my 15 year olds GPC -saga.
    He was in B&L Soflens toric for about a year before GPC started. He dicontinued lens wearing for more than a year and has tried several brands since then. Most still slip after blinking, however most of the professionals who have looked at him say the GPC is not bad at all. He recently tried Proclear toric with a slight tighter fit. The lens isnt slipping like some of the others but the lens feels gritty under the upper lid. My son desperately would like to wear his lenses for sports (baseball). He is getting to a higher level of play and the glasses aren't giving him what he needs. At this point, is this a fit issue and a GPC issue. He has a fairly significant astigmastism . After 15 minutes in lenses, they are uncomfortable. Any thought? Thanks so much!!

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  31. its probably not the "fit". its the GPC. these are the toughest cases. he's young so he can't have lasik. he's high astigmatism so he can't have dailies or any thin lens. there aren't that many lenses for high astigmatism. he's in sports so glasses are out.

    i don't know what to tell you. there isn't great news. i have a 16 year old right now with this EXACT SAME PROBLEM. he's on sparing contact lens wear (only during practice & games) and steroid eye drops. and the lenses still "slip" and he says they're uncomfortable. and i have no answer for him, either. there's no "better" lens or "tighter" fit (that wouldn't work, anyway) etc etc. we're limited by the lack of high-astigmatism products. it sucks.

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  32. "wrap" sports goggles. that'd work. few kids want to do that, tho.

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  33. Thank you so much for your quick reply. At this point, my son would take minimal CTL wear for practice and games. Is your son using a steroid drop
    prior to lens insertion? He has been using one drop of Pataday daily, but hasn't been treated for the GPC in more than a year. Is it worthwhile to discuss retreating with steroid drops and tapering off with our local doctor? He never really had more that 2 weeks on Lotemax. (If I remember correctly) If the upper lids look pretty good, will another course of steroids, take the remaining inflammation down at all, in your opinion? I also read that after GPC, one needs to go to CTL with a different edge and made of polymer modulus. What lens would fit this description? And , yes, there's that astigmatism, that complicates things even more. Goggles /or wrap around Oakley styles aren't compatible with the astigmatic prescription. Have you investigated a custom lens for your son? Would a thinner lens help at all? Thanks again for your insight.
    I

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  34. i meant to say i have a 16 year old PATIENT with GPC & those same problems right now. its not my son, tho.

    "Is your son using a steroid drop
    prior to lens insertion?"

    WHEN you instill the steroid (or any drop) is unimportant IMO. before, after, whatever. ideally if you're on it twice a day you'd be putting it in at least 5 min before insertion...but if its an hour before or 2 hrs before, etc...i dont think that matters.

    "He has been using one drop of Pataday daily, but hasn't been treated for the GPC in more than a year. Is it worthwhile to discuss retreating with steroid drops and tapering off with our local doctor?"

    this question is impossible to answer via the internet. sorry. i dont even know if its "GPC" he has right now if its been over a year since someone saw him.

    "He never really had more that 2 weeks on Lotemax. (If I remember correctly) If the upper lids look pretty good, will another course of steroids, take the remaining inflammation down at all, in your opinion?"

    who knows? yes - if its inflammation, lotemax quells that. but if its not, it wont.

    "I also read that after GPC, one needs to go to CTL with a different edge and made of polymer modulus. What lens would fit this description?"

    ok this is the main crux of the problem. what fits that description is spherical dailies...which don't come in high astigmatism. thats the main problem - he can;t have that b/c its not available in his Rx. if your doc could have done that for you, trust me he/she would have already done that.

    "Have you investigated a custom lens for your son? Would a thinner lens help at all?"

    well this is a trick question. YES thinner would be great! except that you're not going to get any "thinner" with custom made. there is no "thin" low modulus lens thats ALSO HIGH ASTIGMATISM.

    there's no answer for this. i mean yes thinner & low modulus would be great, except he (like all astigmats) can't have thin, low modulus dailies.

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  35. As I said in previous posts (on Jan. 27th regarding Lasik), I am 19 and in college and thus right now don't have access to an opthomologist. When I get back in May I am going to seriously consider getting the surgery. I just wanted to see if I would even be considered for lasik on the basis of my rx history.

    March, 2007:
    OD: -2.00, -1.25, 103
    OS: -2.75, -1.25, 73



    February, 2008:
    OD:-3.00, -1.00, 100
    OS:-3.25, -1.25, 70



    December, 2009:
    OD: -3.00, -1.75, 107
    OS: -3.75, -1.25, 78



    January 5, 2011:
    OD: -3.25, -1.50, 107
    OS: -3.75, -1.25, 067


    Thanks again for all the help and sorry for bothering you so much. GPC sucks haha.

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  36. debatable. you've had 2 in a row that are close, but before that you were not very stable. i'd be a little wary.

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  37. What do you think about switching to gas permeable lenses? The guy above has an astigmatism, gpc, and is complaining of the lenses moving in his eye. Would a hard contact lens be a better option and provide crisper vision, at least for the time being while he is in them playing baseball?

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  38. meh. i'm on the fence. some have stated that GP wear might be good for GPC cases, but i personally don't see it. GPC is generally exacerbated by high modulus (stiff) lenses & mechanical lid interaction...well GP's are the ultimate "high modulus" & thick edge. plus, GP's notoriously fall out under duress like in sports. i personally don't think thats his answer.

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  39. Hey doc! I have been diagnosed with GPC about 3 days ago. I did have bacterial conjunctivitis for about 2 weeks before I came down with GPC, or I think I may have had it all along with the pink eye. However, i stopped using the Zymar drops during the day and the Ciproxin ointment during the nightttime. So for the GPC i am using Prednisolone steroid drops 1 drop in each eye 4x a day. I have seen great improvement, but I want to start wearing contacts again soon because my glasses are really thick--- -9.00 rx! What do you think about it and how about LASIK for me? I am about to turn 20.

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  40. wow this is by far the most commented-on topic on my blog! I dont know if you'd be a good LASIK candidate or not. it depends on:

    1) if your Rx is stable
    2) how thick your corneas are
    3) how big your pupils are
    4) if you have dry eye

    etc etc. sorry! there's way more to LASIK than just how much myopia you have. you'd need a LASIK consult

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  41. Haha cool! What do you think about my GPC? I still get very slight crust formation in the morning and my eyes are still a little pink when i wake up... Should I be concerned? I am still taking the steroid drops but not the pink eye antibacterial drops.

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  42. haha, well...I don't really have any idea b/c I haven't seen your eyes...

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  43. this was sent by "NDesai", but i accidentally pressed "delete" instead of "publish". oops, sorry:

    "Great blog post! I think you can tell by all the comments.

    I had gpc back about 10 years ago due to over wearing. Got it taken care of then, had a relapse about 3 years ago and was given lotemax and plugs. I thought I had a relapse recently and went to the doc. He flipped my lids over and said I didn't have gpc, just some allergic inflammation. Which is pretty likely since my overall allergy reactions are on the sensitive side.

    He recommended alaway. My only concern was it was pretty clear he was being backed heavily by a pharma rep. Do you have any thoughts on alaway in particular and/or any other high end allergy OTC eye drops?"

    my reply:

    well alaway is OTC so doubtful he's being "pushed" to recommend that.

    i think pharma influence on docs is overstated by patients anyway, but thats just my personal opinion.

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  44. Is it possible to get raised papillae from seasonal allergies? I had gpc several months ago with no flare ups and have been out of contacts since then. Recently my eyes have been red and itchy again. The doc said my papillae were .1 under my eyelids. I have not been in contacts at all so how are the bumps back?

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  45. yes, papillae can & often do occur from seasonal allergies. they usually don't become "GIANT" w/o constant contact lens wear, but they certainly can occur w/o it

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  46. Thanks...just wish I knew what I was allergic to :(

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  47. Hi Doctor! Great blog - thanks so much for providing this service!
    My story - I got GPC about 8-10 weeks ago after we sanded and polyurothaned our hardwood floors (at least I think it caused it). Prior to this I wore contacts for 20 years with no problems.
    I wore my glasses for about 3 weeks and this helped a little, but I am one of those people who feel a little better with a contact in I guess. I used Tobradex for 2 weeks, then Lotemax. I also switched contacts to a monthly lens that has higher water content and more "oxygen" to the eye (as my eyes have gone dry with this GPC stuff), and switched solution to the Clean Care system. I've even started Omega 3 fish oil 3 x a day.
    Tomorrow I am to start on Pataday for 1 month.
    Does this all sound like the right course of action???
    I don't have eye redness or itchiness at all - just upper and lower eyelid swelling and discomfort in the upper lids.
    Thanks!!!!

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  48. yes that sounds pretty good. there are different schools of thought on treatment options, of course. i personally avoid use of silicone after a known GPC diagnosis, if thats what you mean by a "more oxygen" lens...

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  49. I also have another, more recent GPC post:

    http://myeyepod.blogspot.com/2011/02/its-gpc-again-margaret.html

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  50. Doctor,
    I wanted to know if you could provide some insight into my situation.
    I had severe dry eye for about a year which prompted me to try various things including wearing a "band-aid" contact lens for the eye. My dry eye went away from this treatment almost overnight but then a few months later I was diagnosed with GPC. I am absolutely miserable. Not because I can't wear my contacts again, but because of how much pain this is. It's been months and I really have had to modify my work, social life, etc. because of the pain. I've been prescribed pataday which helped for a little while and tapered off after a month. I also tried lotomax which really didn't affect me. I am wondering if you had any suggestions on what I should try next/suggest to my doctor?
    Thank you for your help,

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  51. no, sorry. if steroids aren't working there's usually not much else you can do

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  52. So happy to see ur blog!! >.<

    Hi doctor,

    I have been using contact lenses for about 6-7 years. Wearing it most of the time.

    Several several months ago I felt sth wrong with my eyes, felt so uncomfortable that I couldn’t read couldn’t concentrate. So I went to see a doctor. He said my eyes are inflamed. He prescribed me one steroid and one antiallergy eye drops and told me to stop wearing contact lenses for a week. I did so and everything went back to normal and I resumed my contact lenses.

    A few months later I started having the same problem over and over and did the same thing over and over.

    Last month (early May) I went to see the doctor again and I tried not to wear contact lenses again. Until now, I only wore it for 3 days. The thing is I still feel my eyes painful from time to time. It became so unbearably painful that I decided to go check with the doctor again 2 days ago. He said my eyes are inflamed and that I have sth called GPC. He gave me one fluorometholone and the same antiallergy eye drops. (He said I can do LASIK once my eyes are not inflamed which should be in aabout a week.)

    I already made my appointment for LASIK operation with another doctor in early July. The time I decided for this, my eyes weren’t this painful.

    Could u please help answer my questions here:
    - I thought my eyes would be better if I stop wearing contact lenses. Why is it that my eyes are still very painful? Will GPC healed? Or I just need more time.
    - I’m sorry but I don’t quite understand whether the inflammation and GPC are the same thing. I mean are the 2 things come and go together or GPC can always be there (like hidden bumps) but it may or it may not be inflamed.
    - Is LASIK a good choice? Is my appointment in early July too early as I am now curing my painful eyes and my eyes feel so dry? (If not in July I will have to wait for quite some time :’(
    - Which choices of LASIK are best, 1) microkeratome, 2) femtolasik with blade 3) femtolasik (ReLex)

    Sorry to bother u with stupid questions but I really need your advice. This pain really interferes with my life and work. But then im also fear that with current eye condition and GPC, LASIK may not produce a good result.

    Thank you very muchhhh.

    ReplyDelete
  53. GPC can persist after contact lens wear has been ceased. I dont know if your GPC will go away. most do, some dont

    GPC is a form of inflammation. it is not the ONLY form of inflammation, obviously. so yes, GPC and inflammation are the same thing...sort of.

    lasik is a good choice b/c you dont have to wear contacts anymore. contacts exacerbate/cause GPC. you'd be removing the offending agent (contact lens wear)

    as for which lasik is the best...better to ask the lasik surgeon.

    ReplyDelete
  54. And in your opinion, will it be okay for me to get my LASIK early next month? Or should i wait for a while?

    ReplyDelete
  55. sorry I have no opinion on that

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  56. alrite.. thank you so much for your time and help.

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  57. I was diagnosed 6/13/11 with GPC, which was a total surprise other then a tiny amount of stuff in the left eye about once a week, I have no symptoms. The Dr put me on lotemax 6 times a day, I even set the alarm to get up in the night plus wetting drops no contacts until 6/24 visit. Looking back I had the same issue last summer which resolved its self until now. I am so upset, I am wearing B&L multi focal for +3.50 and 4.00 which have been great for years, change once a month, I am very good about not over wearing them, cleaning, etc. I hate wearing the glasses, this is my first day and I have stayed home. LOL. guess my question is do I seem to have a milder case and what other contacts can I use given my vision and the bifocal part. I did not know this existed but could not have done anything different anyways, do you think my associated with some seasonal allergies, I live in NH,?

    ReplyDelete
  58. the 2 biggest foctors in GPC IMO are:

    1) seasonal allergies
    2) silicone contact lens wear

    so...are your B+L contacts "PUREVISION MULTIFOCAL"?

    the thing that usually (not always) solves GPC is:

    1) steroids
    2) DAILIES. no silicone. out of silicone. there is only 1 multifocal daily that i know of (ciba focus dailies progressive)

    those are just my opinions. yes, i think its associated with your seasonal allergies

    ReplyDelete
  59. Yes, the contacts are Purevision Multi-focal. My Dr said she hoped with a different cleaning system and maybe changing the contacts twice a month I will not have any problems. I put myself on Zyrec to help, although I do not feel like I have allergy sysmptoms. Sorta depressing reading all of the problems people have with this, my Dr said GPC sounds worse then it is??? Actually my eyes feel worse right now with the Lotomax then they did before I found out.

    Thanks

    ReplyDelete
  60. Hi I have a question...in my case is somehow unusual.
    I have been struggling with eye problem...even though i have done LASIK last september and i have not wore contact lens for over 2 years, I use steroid eye-drop, Lotemax, and take zyratec one pill a day.

    I went to see a doctor yesterday and Doctor told me I still have GPC and because of that, GPC is rubbing cornea every time i blink...so I am always tearing, light sensitive, blurry vision, redness, feel burning, itchy, discomfort and irritating...
    Since Lotemax did not work for me, Doctor gave me Pred Forte eye-drop and Cromolyn Sodium Eye-drop, and just in case Prednisolone oral pill.
    he told me to come back and see him next week.....

    is there any other treatment for my GPC other than eye-drops????
    or things should do in daily basis?
    I am so stressed with this GPC and cornea problem...

    Please help Doctor!

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  61. "is there any other treatment for my GPC other than eye-drops????"

    unfortunately, no.

    "or things should do in daily basis?"

    not really anything that will help. just gotta be on anti-inflammatories (steroids). sorry! good luck

    ReplyDelete
  62. I see...Ok, thank you very much for the help!

    ReplyDelete
  63. Hi,

    I have a question about my eyelids. I was diagnosed with GPC about three weeks ago. I was on Pred-forte for 10 days (taking drops 4x a day). I am still not wearing contact lenses. I do have dry eyes, nothing severe though. A few days ago I began feeling irritation in the corner of my left eyelid. Using eye drops helps relieve the irritation. I have been using optive refresh and thera tears gel (both preservative free). Could the irritation be the GPC flaring up again or is it just dryness in the corner of my eyes? Or could it possibly be something else?

    ReplyDelete
  64. could be either the GPC or dryness in the corner. could also be something else. I know that wasn't very helpful...but all of those scenarios are possible

    ReplyDelete
  65. I have somewhat of a weird case here... I've been diagnosed over half a year ago with GPC, even though I've never worn contacts in my entire life. My eyes (and especially the right one) have been bloodshot all year round. They have only been better a little while when I was on Dexamethasone, but when I stopped that a few months later my eyes got worse again. As of now I'm still op Patanol and Duratears, but my eyes still seem to be getting redder. Have you ever seen something like this before? Doctors here in The Netherlands don't seem to know much about it, but perhaps that's because GPC isn't supposed to occur when you're not wearing contacts...

    ReplyDelete
  66. yeah there are some weird inflammatory diseases out there. vernal conjunctivitis, etc. if they were better while you were on dex, and worse again off, that makes a strong case for trying longer-term steroids. is Lotemax avail in the Netherlands? that'd be a lot safer than long term dex use

    ReplyDelete
  67. No it isn't, although perhaps FML liquifilm (Fluormetholone) is a safer alternative as well? I've been prescribed those drops in the past as well though they weren't as effective as dex. It's a shame Lotemax isn't available here, I've been seeing that name all over the web.

    Thank you for your quick answer

    ReplyDelete
  68. yes FML is probably safer long term (and lotemax safer still) than dex.

    ReplyDelete
  69. Thanks SO much for your post and expertise! I too was just diagnosed with GPS, but I have been wearing FOCUS DAILIES "One-day contact Lenses" for four or 5 years. Since I throw them out every night - I'm confused how they could have accumulated debri that would chafing issues all of a sudden. Also my eyes are reddest and worst when I first wake up in the morning - after I've been out of my contact lenses for hours.... I'm wondering how often you - or your readers -- have encountered GPS among people who wear daily disposable contact lenses? I'm just wondering if maybe I have something else.... Thanks again for sharing your insights! Best, Red & Itchy in NYC

    ReplyDelete
  70. yes dailies can cause GPC in a person with a hearty immune response. its not "debris" that causes chafing, its the lens. dailies are thinner & cause less chafing & can solve the problem in most people, but not all, obviously.

    yes i have some patients who have GPC even in dailies. some of them have had to discontinue all lens wear.

    ReplyDelete
  71. thanks doc!
    Is is unusual that it the chafing/GPC would develop suddenly after wearing dailies for years? Does this suggest that glasses or Lasix is my only option?
    Red & Itchy

    ReplyDelete
  72. "is it unusual"? nah. I always say that anything goes. it ain't rare if it's in your chair! :D

    if you can't wear dailies w/o GPC bothering you, then yes it sounds like probably glasses or lasik

    ReplyDelete
  73. Hi doc - thanks for the great post! So my situation: Had GPC seasonally, most recently an extreme case. Oph put me on steroid and pataday and switched from acuvue biweekly to acuvue dailies. Dailies are so expensive though - what are you thoughts about staying on acuvue biweekly, but just switching/disposing weekly?
    I'm at -10.0 both eyes so not many disposable options probably.
    Also - I am not a candidate for LASIK, would I be a candidate for PRK and what are your thoughts on PRK?
    Thanks!

    ReplyDelete
  74. I think dailies are better than bi-weeklies for GPC. thats just MO. especially in high minus. agreed they're expensive.

    i stopped referring the high minus cases for lasik or prk or anything. just too many problems/headaches. i don't refer over about -8.00 anymore. admittedly thats conservative, but we just have to spend so much time on them and they have so many problems. there are plenty of offices out there that say its no big deal, but i just quit referring the high minus cases. its kind of funny tho- those are the ones who are the MOST interested in lasik, for obvious reasons.

    ReplyDelete
  75. ^^ What about lens implantation for high minus??

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  76. I would refer for that, but I have to admit I have yet to do it.

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  77. Hi doc - thanks for the great info. A few questions if you can help provide some insight:

    - doc put me on Pataday throughout the year since I had a recent extreme case of GPC in right eye. Better now after steriod use for 2 wks and daily pataday. Does your body develop insensitivity to pataday with daily use? Should I continue even though GPC conditions are better now? I'm concerned that when allergy season comes around, pataday will lose effectiveness if I use year-round
    - Which is better dailies for high prescription -10.0s slight astimatism: Acuvue dailies or Ciba dailies? Both do not contain silicone and equally thin?

    Thanks in advance for your input!

    ReplyDelete
  78. "Does your body develop insensitivity to pataday with daily use?"

    no. in fact chronic use stops the formation of new infammatory cells. so longer use works BETTER

    "Should I continue even though GPC conditions are better now?"

    up to you & your doc, obviously...but that's what I tell my patients to do. especially if you plan on continuing to wear high minus contact lenses

    "I'm concerned that when allergy season comes around, pataday will lose effectiveness if I use year-round"

    no, it will not lose effectiveness

    "Which is better dailies for high prescription -10.0s slight astimatism: Acuvue dailies or Ciba dailies? Both do not contain silicone and equally thin?"

    personal preference. whichever is more comfortable. they're equal in my mind

    good luck!

    ReplyDelete
  79. GPC sucks! I'm 3 weeks into an eye infection that won't go away. I'm on tobradex and pataday. My GP gave me polytrim when we thought it was simple pink eye, then it got worse. My eye dr now says my infections are more systemic so I'm on Zyrtec and going to my GP for gluten intolerance and STD testing. Not fun. I've had swollen tonsils for 7 weeks (I did have strep but its gone now) and conjunctivitis for 3 weeks. And now my ear hurts. Seems like it never ends, but I have to say the one night/next morning of severe eye pain is 10x worse than the ongoing throat pain. Super bummed I can't do extended wear contacts anymore.

    ReplyDelete
  80. are acuvue 2 contacts ok if you have reoccuring GPC?

    ReplyDelete
  81. Probably better than a silicone lens, yes. Av2 is plastic with rather low modulus. But one of the things that really can matter is where the edge ofthe lens sits in relation to your individual pinguecula, which is obviously variable by patient. So it's hard to say if av2 is right for *you* or not...

    ReplyDelete
  82. Hi I am living in Ireland and was told by an optician I had mild GPC. He told me to use Brolene (It is Propamidine Isetionate for mild infections) so I used this for about 6 days and seemed to be improving. I use monthly lenses and he told me to give my lenses a really good clean - I am so annoyed that I listened to him about being able to use the same lenses again!! obviously they were infected but I just listened to the proffesional and ignored my own thoughts on it and was due a contact lense check the following week. Scrubbed them lenses and put them in for the morning while I had the check. It was with a different optician and she was obviously shocked that he had said I could put the contaminated ones in!I knew by her face it was a no no and really wish I had just put a new set in. ANYWAY, since then symptoms got worse than they were originally! woke up next day with REALLY itchy corners of my eyes and sticky eyes in the morning. Went to my doctor then who didnt have a clue what GPC was and my heart sunk. He just gave me Sodium Cromogulate drops which I have been using for nearly 6 days and they are'nt really doing a thing. The intense itch is gone but eyes are still sticky in the morning and one eye is particularly red in the corner...Can you suggest anything for me?!! as I feel no one has a clue here....Should I ask for a steroid drop to clear it as I really need to use lenses for sport! Is it ok to still use disposables the odd time? I dont mind wearing my glasses for the majority of the time but I do need them for nights out and playing sport..... please help!!! Thank you.

    ReplyDelete
  83. so many things to address here. 1st of all "Brolene" is an antibiotic. GPC is an inflammatory problem. it is not an "infection", so antibiotics are not indicated. also since it is not an "infection", re-using the same lenses will not be harmful. they are not "infected" nor "contaminated".

    it always bothers me when people post that their doctor was "shocked" at what some other doctor did. who are these people who are allowing themselves to be "shocked" in front of a patient? I never do that. a doctor should have a relatively even keel IMO, in front of the patient, anyway. but I digress.

    the doctor who "didn't know what GPC was"...gave you a mast cell stabilizer (Sodium Cromoglycate), which is at least on the right track if the diagnosis really is "GPC". that's a better idea than an antibiotic was. mast cell stabilizers take a notoriously long time to "work" b/c you have to wait for your mast cells to "turn over", which can take up to 21 days/. so it's not surprising that you've had no relief in the 6 days you've used them.

    I am going to suggest to you what I suggest to everyone with GPC:

    1) steroids
    2) dailies

    steroids & dailies. it's THE fastest/best way to get rid of GPC. fooling around with antibiotics & mast cell stabilizers, and giving the lenses an "extra cleaning" etc etc etc...well IMO none of that works very well. those treatments are usually not aggressive enough IMO.

    steroids & dailies. preferably Lotemax as the steroid and the thinnest dailies you can get in your Rx...not a silicone daily like "Trueye". more like Ciba Dailies Aqua Comfort Plus.

    ReplyDelete
  84. Thank you for your write up on this. All the information is so helpful. I was unfortunately diagnose with this back in Dec2011. I was told to go three weeks without contacts, with Patanol drops. My insurance did not approve the drops and I was given a substitute. I used it for 2 months and then resumes the wear of my monthly lenses. After using them for 3-4 weeks, the problem was back. Then I was put on a steroid drops for 3 weeks. I started back using my contacts after the third week but began having problems again in the same week. Now I'm back to glasses and have not been back to the eye doctor yet.

    I am seriously hoping this goes away because I cannot stand glasses, but I have been following the doctor's advice.

    I has resumed my drops (alternate to patanol) again. But wearing lenses even for 4 hours is an ordeal now.

    What do you suggest?

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  85. Dailies. Seriously. If its really that bad you need dailies & lotemax. If patanol & your regular monthlies are not cutting it, gotta get more aggressive.

    ReplyDelete
  86. I have dry eyes. I'm 39 and I've worn contacts for about 25 years. Up until 3 or 4 years ago, I never had any issues and wore contacts 14-16 hours a day. Now my eyes are dry - always a little dry and sometimes miserably dry, whether I wear contacts or not, but they're admittedly a little worse when I wear them. I have a few questions - (1)If I stop wearing contacts forever, could the dry eye go away? Right now, it's worst in the morning. (2)Is there a contact lens I could tolerate? I have tried Focus 1-2 week lenses, Acuvue Oasys & Air Optix. The Oasys lenses are horrible - my eyes feel terrible after wearing them.

    I have been to an opthomologist, who initially said my meibomian glands were blocked. He prescribed doxycycline, which took a few weeks to work, but worked miracles. That lasted 6 months. I went back, he prescribed doxy again - but it only worked for 2-3 months. The third time he prescribed it didn't seem to help at all. He's suggested plugs, but apparently I don't make tears - the Schirmer test revealed "almost none", so I wouldn't expect plugs would help much.

    ReplyDelete
  87. 1) if you really have "almost none" as far as tears are concerned...then no, it's unlikely that ceasing CL wear will completely fix your problem. POSSIBLE? sure. likely not tho IMO

    2) I don't know if there's a contact lens you can tolerate or not. there are plenty to try. In the case of a known dry eye patient my favorite lens to try (assuming it comes in your Rx and size, etc) is Ciba Dalies Aqua Comfort Plus. I also like Coopervision's Proclear (a monthly)

    in these cases my next thing to try is RESTASIS. have you tried an Rx for Restasis?

    ReplyDelete
  88. No, I haven't tried Restasis but it sounds scary because it's a steroid. I'm really nervous about meds in general, especially long term meds. The opthomologist hadn't mentioned that - to be honest, I don't think dry eye is his specialty, per se. It took four visits to get a Schirmer test.

    Hot compresses don't really help, but they feel good while they last. Fish oil sort of helps. I keep trying to figure this out, like why it's so variable - right now, my eyes are so dry, but 2 weeks ago, only dry in the morning or after about 4 hours of contacts. I wonder if it's the coal tar shampoo I use. If stopping contact lens wear won't help, will wearing them hurt? I don't want anything to be worse!!

    My prescription is 8.00 in the right eye & 7.00 in the left, 14.2 diameter & 8.4 BC.

    ReplyDelete
  89. Restasis is not a steroid. Restasis is cyclosporine, which is "in a class of medications called 'immunomodulators'. It works by decreasing swelling in the eye to allow for tear production" http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000253/

    I'm not a big fan of a Shirmer test, either FTR.

    I doubt its your shampoo.

    Wearing contacts cannot make your eye drier. They just exacerbate the SYMPTOMS of an already dry eye.

    I hear you on not wanting to take meds, but if you're miserable, Restasis is probably the next step. so you have to weigh the amount of misery you have vs how motivated you are to stay away from drugs, you know?

    I'd at least try switching to dailies. That's an easy thing to try, and it has pretty good success.

    ReplyDelete
  90. Wow, thanks. I feel embarrassed to be so ignorant about all of this and so grateful for your help. I'm thanking God & pray He'll bless you for being so helpful. :)

    I noticed the lenses you recommend don't come with a basal curve of 8.4 like my old lenses, but with 8.7 or I think 8.6. Is that significant? Could I wear that size? I don't understand how that works.

    I'm definitely going to try these lenses if I can. I switched to a different brand of fish oil - I've tried maybe 4 brands now and some seem to help more than others. I'm hoping maybe this last batch was responsible for this bout of drier eyes.

    Thanks again & God bless you!

    ReplyDelete
  91. this is one of the most asked question on the internet about contact lenses. "doc, I wear ___ size/brand/shape/material. could I wear ___ size/brand/shape/material?" and the answer is...who knows? only the person who is looking at the lenses while they are on your eyes would know that. lenses that are too loose/small will be immediately uncomfortable, but lenses that are "too tight" or too large feel GREAT...for about 4 hrs. so most patients are unable to "fit" themselves. some eye doc somewhere is going to have to help you switch sizes/shapes/brands/modalities of contacts. sorry!

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  92. Good to know, thanks!

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  93. Hi doc, I have a question for you. A little history first. For years I wore Acuvue 2 with no problem, then I started sleeping in them for way too long, thus I set up neovascularization (sp??). Anyway switched to Air Optix Astigmatism and no longer slept in them at all. I wore the Air Optix for a couple years with no problems other than foreign body sensation-eye doc said I had tiny bumps under my eye and probably due to solution. Changed to Clear Care and started using Alaway and it got better. In February my vision started getting blurry and contacts started getting many deposits and night vision was awful. Doctor said dry eye, use Systane. Trialed Biofinity Toric and Purevision 2 for Astigmatism. No change. Then they told my it's dry eye-deal with it or wear glasses and I was expecting perfect vision and that would never happen because of astigmatism. Went to another eye doctor who said let's try this-your astigmatism isn't bad (.75,1.0) let's try regular Air Optix and see what happens. That stopped the blurriness and things got better. Now I am starting to tolerate my lenses less and less. My eyes are always dry (however, it is summer and I live in the south) and lately sometimes they burn like I haven't had enough sleep, however they are NEVER red. So I was wondering if this could be a flare up of GPC without the red eyes? Anyway I have talked my doctor into giving me a trial of Soflens Daily, but the doctor who diagnosed neo isn't here anymore, so it is a new doctor. Could the low dk of the soflens cause problems for me? I know it could I guess, but since I had neo several years ago, would the dailies still be ok? I would probably wear them for about 16 hours a day. Thanks for any advice you can give me.

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  94. "So I was wondering if this could be a flare up of GPC without the red eyes?" Yes, that's possible

    "Could the low dk of the soflens cause problems for me?" VERY FEW cases of neovascularization are in patients who wear dailies, b/c they're never sleeping in them. It's almost always the "extended wear" (sleeping in them" that causes the neo, not the "Dk" of the lens, although that's obviously a factor.

    for MOST people MOST of the time, 16 hrs/day of low-Dk dailies wear will not cause neo.

    You have inadvertently opened up a can of worms that I want to address. Maybe I'll write a new blog post about it...yeah I think I will

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    Replies
    1. Thank you for addressing my concerns. You were very helpful and I am glad you have this website. Sorry about opening up the can of worms lol.

      Delete
  95. Was diagnosed with GPC on 8/27 when the Dr. finally flipped my lid and saw the problem that I had been complaining about since 7/14. So I suppose that the GPC had started back then. I started with Patanol on 8/27 and added Lotemax to the regimine on 9/1 after another visit to the Dr and little improvement with Patanol. The Patanol does seem to take down the puffiness - especially in the morning. Woke up on 9/2 with severely puffed lids - esp. the left eye which has the GPC more severely than the right-not sure if this was caused by Lotemax or coincidence that I just added
    it to the regimine the day before. I've been wearing contacts for 30 years and never had an issue like this. Most recently on 4/9, I changed brands from Frequency 55 to Biofinity - both are manufactured by Coopervision, however, the materials are HEMA and Silicone Hydrogel respectively. Freq 55 - 55% water, 0.07 thickness. Biofinity - 48% water, 0.08 thickness. In some blogs I've read there seems to be a higher incidence of GPC with
    Silicone Hydrogel lenses. Could my change in lenses have triggered this awful, itchy, painful predicament?

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    Replies
    1. Here's how my GPC condition is coming along. I was on Lotemax from 9/1/12-9/10/12, also using Patanol during that time. Lotemax worked great, took the swelling and itchiness away, the bumps receded significantly and I was so happy and thought that I was in the clear. 2 days after stopping the Lotemax, I felt the itch again in the right lid. My follow-up with the Dr. on 9/13 - I told her the right eye was starting to feel itchy again, but she was very pleased with the results she saw in both eyes. She told me to stay off the Lotemax, continue with the Patanol, and gave me samples of 1-day acuvue moist dailies. I wore the dailies on 9/14 for about 6 hours and felt fine. Woke up on 9/15 with two big puffy red eyes again. Although she told me to stop the Lotemax, I put one drop in each eye as I feel it's going to continue to get worse. I feel that the Lotemax is the only thing that is helping, since as soon as I stopped, the itch started to come back. There must be something else to this - why did the itch start to come back when I wasn't wearing the lenses? Is using the Lotemax once a day a bad thing? I am also taking Zytek just for the heck of it to try and reduce any allergens. I don't have allergies normally, but apparently there is something going on. I'm going to make an appt with another Dr to get another opinion, as this condition is ridiculous. I guess for now, I'll do the Lotemax once a day and stay out of the lenses until I can get to another dr. Doesn't seem like much else can be done based on everything I've read so far.

      Delete
  96. YES. if you've read this post and all the replies as well as my other GPC posts...

    GPC is caused by allergies + silicone. go back to plastic (HEMA), preferably dailies.

    ReplyDelete
  97. Is there anything else I can possibly do?

    I don't understand how I got GPC. I never slept in my lenses, always cleaned them with Clear Care, tried daily lenses, never wore contacts for more than 9 hours at a time and only wore them about 5 days out of the week.

    My doctor diagnosed me a little over two months ago. I stopped wearing contacts entirely and used both an eye steroid and artificial tear drop. When I went back to the doctor, he said it was only a little better and that I need to discontinue wearing contacts. I also have some scratches on my cornea from it that haven't cleared up at all. He's given me Zatidor and some eye lubricant while we slowly give dailies another try in a month or two.

    What else can I do? I was always the textbook patient for contacts!

    ReplyDelete
  98. not much else you can do. steroids & dailies. if that doesn't work, glasses or lasik

    ReplyDelete
    Replies
    1. So interesting that I've encountered this site! It's crazy how many people are affected by GPC.. And also partly due to wearing Acuvue products. Makes you want to sue them!

      In any case, I was diagnosed with severe GPC by one of the top eye surgery/doctors in the country (in the Boston, MA area). In fact the doctor was shocked how bad it was, and took photos and they are doing further research.

      I've been a contact wearer for 20 years, mostly have been wearing the Acuvue brands, tried the 2weeks and the dailies (most recently Acuvue Moist dailies). One day I had pain in one eye and immediately removed contacts and the bump on my lid worsened daily.

      Delete
    2. to continue from my previous post..

      I saw a few optometrists and was recommended to see this well-known specialist in Boston/Cambridge area. This doctor was extremely firm upon giving me the diagnosis - no contacts ever again. I was told to throw them all out, and was prescribed Lotemax and Lastacaft. I had been trying Alaway and was told it was fine to use that as well. Since drops aren't a long-term solutions due to it possibly causing cataract and glaucoma, he told me to see an allergist at one of the top hospitals in this state.

      The allergist found that I'm highly allergic to most grasses, trees, and animals (cats, dogs, horses, etc). Therefore, I was probably not the best candidate for wearing contacts.

      I've stopped wearing contacts for a month and the symptoms went away. Without the doctor's consent, I wore the dailies for a few hours here and there (maybe 3-4 times a month).
      Allergy season must have returned.. as the symptoms are back, with more itchiness rather than large bumps under my lid.

      This has upset me as I dislike wearing glasses.. But now I've found some funky glasses so I'm slightly more tolerant to them. However, I'm looking at the option of lasik.

      Once the symptoms have gone away, is it safe to try lasik?
      I'm a little weary of lasik.. But would love not having to wear glasses. Opinions?

      Delete
  99. it's not "Acuvue" brand that causes GPC. it's allergies and silicone. nothing wrong with Acuvue.

    ReplyDelete
  100. "Since drops aren't a long-term solutions due to it possibly causing cataract and glaucoma"

    that's not really true with Lotemax. older steroids, yes. Lotemax, no.

    "The allergist found that I'm highly allergic to most grasses, trees, and animals (cats, dogs, horses, etc). Therefore, I was probably not the best candidate for wearing contacts"

    haha no offense but this is what "the allergist" always says. no kidding, you have seasonal allergies? good to know! #wealreadyknewthat

    "Once the symptoms have gone away, is it safe to try lasik?"

    probably

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  101. Before stumbling upon this article, I was actually researching more about switching back to silicon hydrogel lens. I am so glad to have read through this blog entry and the comments!

    Some background information: I used to wear Acuvue Oasys for Astigmatism (also even Acuvue Advance), but after several reoccurring eye infections and horrible ocular allergies, my ophthalmologist forbid me from wearing contact lens for awhile. I went back to the same ophthalmologist several weeks ago and he said I could start wearing contact lenses again, but this time they have to be daily disposables(Acuvue 1-day Moist for Astigmatism). He also prescribed Pataday for me to use before putting on the dailies.

    Before switching to the dailies, I think I may have had corneal neovascularization from my prolonged usage of Acuvue Oasys. I have veins coming from both corners of my eye and heading straight towards the iris/cornea. I am concerned about using the dailies on a full day (give or take 16 hours) because Acuvue 1-day Moist has a low DK/t. Would it be a bad idea to keep wearing these dailies with the risk of further risk of hypoxia and corneal neovascularization? I only wear contacts on the weekdays and give my eyes a break on the weekends.

    I was actually wondering if I should switch back to silicon hydrogels... Better yet, would the dailies exacerbate the neovascularization even if I don't sleep with them on?

    I would greatly appreciate any advice and information you can provide! Again, I'm glad I stumbled upon this entry of yours, Doctor, because I was close to asking for another trial pair of silicon hydrogels.

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  102. IMO *most* neo is from extended wear (sleeping in contacts). VERY VERY FEW dailies wearers ever get neo. so I wouldn't worry too much about neo from the "low dk" of dailies

    ReplyDelete
  103. I'm so glad I stumbled across this blog. I think I've read every comment here on GPC and I just ordered some plastic dailies. I'll be going to an optician to ask about lotemax as well.

    The symptoms started after a case of blephritis. The bleph went away but the GPC has gotten worse and worse. It's especially bad in the morning, is that usually the case? I also think all the problems began after exposure to mold, does that make sense?

    I'm also glad you mentioned a cold compress because hot doesn't seem to work, it might even make it worse.

    I don't think I have a severe case, at least not anyway. In your experience, what is the probability of a recovery? (to the point where I can wear dailies normally?)

    Finally, I was wondering if you had any thoughts on the link between eye problems and depression.

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  104. "It's especially bad in the morning, is that usually the case?" - there aren't really any "typical" times of day that GPC symptoms are worse. different in every case

    "I also think all the problems began after exposure to mold, does that make sense?" - well, if you're allergic to mold...then yes!

    "In your experience, what is the probability of a recovery? (to the point where I can wear dailies normally?)" - when GPC sufferers switch to non-silicone dailies there is a VERY HIGH success rate.

    "Finally, I was wondering if you had any thoughts on the link between eye problems and depression." - many, many times health problems lead to depression. I don't know the specific stats tho

    ReplyDelete
    Replies
    1. Thanks for the response, have a great day.

      Delete
  105. hi there princeldoc, just a really quick question as im curious to know that I should have high hopes of this going away, I'm sort of in the middle of stage 1 and 2 gpc, was wondering if youve had much success with treating stage 2 gpc completely, and usually many weeks/months would it take? appreciate your input, thanks a bunch!

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  106. well yes and no. yes I've had success treating "grade 1-2 GPC", but not "completely". most people with GPC still have some degree of GPC either chronically or recurrently if they don't remove themsolves from their allergen and they don't stop wearing contacts completely. usually we treat them just to get the GPC under control enough so that they have few or no symptoms...but we're not really "curing" it or making it go away "completely". usually the only way to make it go away "completely" is to completely stop wearing contacts

    ReplyDelete
  107. Hi. I've been wearing contacts for 10 years now. B&L soflens toric with a -7.5 in each eye. I was recently diagnosed with moderate to severe gpc in my right eye, and very minor case in my left. Not sure how I got it. To save a little money, I went from using Replenish to Refresh. Otherwise I'm good about changing my contacts once a month, but recently I went on a trip and had to wear an old one in my right eye because I was out of contacts. But I'm pretty sure the GPC started before then.

    Anyways, could switching solutions cause gpc or make it worse? I haven't had issues ever til now, just some mild dry eye.

    My usual OD is about an hour from where I now live, and she had a month wait to get me in to see her. So I found a local OD near my work and current location. He diagnosed me with the gpc, prescribed drops called Prednisolone or something like that. Told me to take them once a day for a week and stop wearing contacts.

    So I did that, wore the contacts and a couple days later I was back to having issues. Went in and he said use Patanol twice a day for 2-3 weeks and again stop wearing contacts. I'm currently one week into the Patanol and I don't think things are much better. I had to wear contacts for five hours yesterday to drive and I could tell the gpc was still in my right eye.

    After reading your blog, I'm afraid this eye dr isn't being aggressive enough. What do you think? He hasn't prescribed Lotemax. Should I try to find a different eye dr, and if so, how do I find out they'll be aggressive in their treatment? I cannot stand wearing glasses because I don't see well in them.

    I'm looking into LASIK but have been told I'm a borderline candidate. I've tried other brands of contacts in the past and none were comfortable. The softens toric are about the only ones that sit correctly on my eye.

    So I guess what I'm asking is, is my dr being aggressive enough? Should I give the patanol another week? If gpc cannot be cured for me, will I do my eyes harm by wearing contacts and putting up with the pain and discomfort if that's the only way I can avoid glasses? Do those lenses you wear at night that correct your vision while you sleep help people with a script as high as mine including astigmatism? Any help and info you can give would be appreciative. Thanks! Megan

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  108. these are the toughest cases: high minus TORIC wearers with GPC. they're tough b/c:

    1) can't have dailies (no high minus toric dailies that are thin enough)
    2) REALLY motivated to wear contacts b/c glasses are heavy & unsightly
    3) HEAVY contact lens wearers, again b/c glasses are not fun in this Rx

    the 1st thing you should do is throw your soflens toric lenses away more often. those are 2-week lenses, not "monthlies". they're designed for 14 wears. *some* people who don't have GPC can sometimes "get away" with wearing them longer, but a known GPC patient is just compounding things by trying to wear them a month.

    no, I doubt the change in contact lens solution played a major role. it's possible that it's a factor, but IMO probably not much of one.

    I don't like Pred for GPC. pred works better for INTERNAL inflammation like "iritis". it doesn't do very well for SURFACE inflammations like GPC. Lotemax is better for those, again IMO

    yeah if it was me I'd switch to Lotemax and go way more times per day. pred 1x/day isn't going to do much, probably.

    no, you're not a candidate for "Do those lenses you wear at night that correct your vision while you sleep" (ortho-k). your Rx is out of range.

    wish there was better news. actually soflens toric is about the best you could do in this type of Rx. don't switch brands...that's unlikely to help much. throw them away after 14 wears, see if you can get an Rx for Lotemax and see if you can find someone to Rx it way more often (say 4x/day or even every 3 hrs). MAYBE switching contact lens solutions COULD help...and that's something else you can control. maybe try totally preservative free Clear Care.

    good luck!

    ReplyDelete
    Replies
    1. Well I got the Lotemax, it's prescribed 4x daily. The drops are like foamy bubbles, is that what they're supposed to be? Also, how do they get to the upper eyelid where the inflammation is if you have to out then in a pocket on the lower eyelid? Thanks! Megan

      Delete
    2. "Well I got the Lotemax, it's prescribed 4x daily. The drops are like foamy bubbles, is that what they're supposed to be?"

      yes

      "Also, how do they get to the upper eyelid where the inflammation is if you have to out then in a pocket on the lower eyelid?"

      no just put a drop in your eye. it'll get there (to the back of your lids)

      Delete
  109. Hi, thank you for your fast response! Ok, so I called my usual eye doctor (I'm in the DFW area so not terribly far from you) and she got on the phone with me. Told her what all we've tried and asked about the Lotemax. She said that was a good idea and called me in a prescription (haven't picked it up yet so not sure how often it'll be for). The office also said to continue the Patanol. So the plan is to take Lotemax and Patanol for a week while continuing to not wear glasses. Then try contacts after a week is up and see how they are. Do you think this is long enough to try the Lotemax for or would it take more time in a moderate to severe case? Should I throw away the pair of contacts I tried after the week of prednisolone (they only have 3-4 days of wear on them) or can I wear them?

    How do I take the Patanol with the Lotemax? I'm not too sure how long to wait between taking these two medications.

    It's interesting that after wearing this brand of contacts for 10 years, I never knew they were for two weeks and not a month! Thank you for that info--I'll start on that regimen if/when I wear them again.

    My eye dr also said she's going to try me on the 1-Day Acuvue Moist for astigmatism. I have my doubts they are going to work because I've tried every brand and none have fit/been as comfortable as the Soflens. And unfortunately, the Soflens Toric Dailies don't come in my astigmatism (-2.25 in one eye, -1.75 in the other). But, I’m going to ask if we can try them anyways in the highest astigmatism available and see if I see well enough. We’ve struggled to correct me to 20/20 the past couple of years because my eyes stabilized, and we can’t find a good match with the axis. My vision is stable but the astigmatism got worse we think. I probably only see 20/40 or 20/50 corrected with contacts. I see a noticeable double vision, especially when looking at a light source. Anyway to combat this and to help alleviate the double image? It seems that we’ve tried just about every single axis there is (the left eye is the main issue).

    If GPC doesn't go away and I'm stuck with it forever (hopefully not!), it won't damage my vision, right? With me, it's not painful--just annoying and sometimes it feels like something is in my eye. But I'm about to the point where I'll put up with that to wear contacts again. In that case, would continuing to use Patanol daily help somewhat?

    Also, do you think I’m a good candidate for lasik or prk? I had an initial consultation and they said I have a 50/50 chance of being a candidate. I have an appointment next week for a more thorough exam to see if I’m a candidate, but not sure if taking Lotemax will affect that any (may have to reschedule the consult). From what I’ve been told, I have normal cornea thickness, perhaps just a tad on the thin side but still normal range. My prescription of contacts is:

    Left eye: sph -7.5, cyl -2.25, ax 170
    Right eye: sph -7.5, cyl -1.75, ax 30

    Thank you for your help! I’m only 29 so the prospect of having GPC in the future and not many vision options is kind of disheartening. Is there any other treatment for my vision, maybe something new/experimental? I work for an airline so traveling to a different part of the US wouldn’t be a major problem.

    ReplyDelete
  110. whew a lot to comment on.

    "So the plan is to take Lotemax and Patanol for a week while continuing to not wear glasses. Then try contacts after a week is up and see how they are. Do you think this is long enough to try the Lotemax for or would it take more time in a moderate to severe case?"

    "severe" cases usually take way longer than a week. more like 6 weeks. guess it depends on how "severe" we're talking about.

    "Should I throw away the pair of contacts I tried after the week of prednisolone (they only have 3-4 days of wear on them) or can I wear them?"

    since this is not an "infection" you can keep/wear the contacts.

    "How do I take the Patanol with the Lotemax? I'm not too sure how long to wait between taking these two medications"

    you probably don't need both. steroids interrupt the inflammatory process higher up in the pathway. in theory, they're doing the work of the antihistamine AND MORE. both is probably unnecessary. but a general rule of thumb is 2-3 min between drops.

    "My eye dr also said she's going to try me on the 1-Day Acuvue Moist for astigmatism"

    I love this plan!

    "Anyway to combat this and to help alleviate the double image?"

    not really. not anything your doc hasn't already tried, probably (axis changes, etc)

    "If GPC doesn't go away and I'm stuck with it forever (hopefully not!), it won't damage my vision, right?"

    right

    "With me, it's not painful--just annoying and sometimes it feels like something is in my eye"

    that's everybody. GPC is not "dangerous. only annoying

    "But I'm about to the point where I'll put up with that to wear contacts again. In that case, would continuing to use Patanol daily help somewhat?"

    if you're going to stop the lotemax: yes. if you're still on lotemax: no probably not

    "Also, do you think I’m a good candidate for lasik or prk?"

    dunno. would have to see your topographies, pachymetries, etc. the LASIK people would know more than me b/c they have your corneal measurements in front of the, all I know is your contact lens Rx

    "Is there any other treatment for my vision, maybe something new/experimental?"

    not really. good luck!

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  111. Your articles support me a lot in all mediums of subjects.Can-C in stock

    ReplyDelete
  112. Can a soap/detergent/shampoo etc cause gpc or any other type of conjunctivitis? Or are the allergens (aside from contacts) that trigger this issue only environmental issues like mold and pollen?

    ReplyDelete
  113. in theory any irritant could cause an inflammatory reaction. so...yes

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  114. How can i get rid of HOA due tobig pupils ?

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  115. Hi Doc,
    I know this is an old post, but if you're still monitoring it I have a question for you. Are blisters on the eye ever associated with GPC?

    My HPI: I've had GPC for about a week now, was only given Nevanac but I bought some Zaditor OTC and started that after doing some research and realizing Nevanac wasn't gonna help me out. I couldn't see my regular OD, as he was booked, so I saw an ophthalmologist I was unfamiliar with. He gave me the dx and Nevanac and said no follow up was necessary. I was thinking about following up with my OD anyway, but hadn't yet called.

    Then today I rubbed my eye as a reflex d/t the itching. Awhile later another nurse said my my eye looked bloody. I took a look in the mirror and saw some thin tissue hanging at the edges of this new blood-red area, then saw the all of the intact blisters. They cover about half my eye: all the sclera on one side of my iris and a little bit of the iris, but not the cornea. I assume I ruptured a few when I rubbed my eye. Also, it might just be in my head, but prior to this my only "pain" was burning and itching, really not pain, just uncomfortable. Now I (think) I feel actual pain, like an ache, in that eye. It's too late to call my OD today and he's off on Fridays so I can't talk to him or see him tomorrow.

    So to conclude, I know you can't tell me much since you can't see my eye, but do you know what these blisters could be? Are they r/t the GPC, maybe from the friction with the papules under my lid? And more importantly can I wait to see my own doc on Monday or should I see another stranger doc tomorrow? I really don't want to see another doc since the last appt was a huge waste of time and money. Or maybe hopefully this is a normal, benign thing that's nothing to worry about?

    Thanks for your time, and even a little bit of info would be appreciated and let me rest a little easier!

    Kelly

    ReplyDelete
  116. A large bump/lump over the sclera is almost always a punguecula, not a "blister".

    GPC can occasionally bleed, but its not very common. Pings do not bleed.

    None of this sounds serious so you can afford to wait and see your regular doc, but I think there is some confusion over your diagnosis or management

    ReplyDelete
  117. Is it normal to not have any eye mucous? I always used to every morning when I woke up (a couple of years ago). I would wake up, my vision would be kind of cloudy and a would simply rub it out of the corner of my eye with a fingertip. Now however, I don't have any. Is this bad?

    ReplyDelete
  118. Hi, I'm on the fence about going to an opthamologist. I had problems for years with GPC. I have been out of contacts for 14 months and on my last eye check my doctor confirmed that I still have it (seems like that should have cleared up by now). She put me back on pataday but I feel like that's not really helpful. Everything else I have read indicates that most cases clear up after a few months. Thanks!

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  119. I hear you. these are tough. if you'v been reading my blog I am very opinionated on this. steroids and dailies. steroids and dailies. steroids and dailies. I cannot say this enough times. if you REALLY DO *still* have GPC, then an Rx for pataday probably isn't going to do much IMO. I like pataday. I Rx it like crazy. but for moderate-to-severe GPC it is usually a drop in the bucket. not nearly aggressive enough IMO.

    *SOME* cases of GPC are permanent. I am running into more and more of these. put them on steroids and their immune response is so hearty that they just can't shake it. I end up taking them out of contacts permanently. some of them spring for LASIK. others are not LASIK candidates for whatever reason.

    but I can tell you what probably won't work: continuing with 2-week lenses and using pataday. that is unlikely to be the answer IMO

    ReplyDelete
  120. Hi there, Firstly, thank you for writing such an informative and honest blog, it has proved so useful in educating myself about GPC. I have had issues with my eyes for the last 5 months, and as I am an actress who needs to wear contacts for my job, I have been aggressively persistent with doctors and opthamologists, only recently with some success. It started with itchy eyelids, some swelling and intolerance of contact lenses, then progressed to big red veins on my eyes, and patches of redness that just wouldn't go away. I also get foreign body sensation several times a day, and dry eyes most days, especially when I'm in an air conditioned room. Doctors thought is was bacterial, then allergic conjunctivitis, so I went through presciptions of Chloramphenicol, then Sodium Cromoglicate (which helped a little, but not much). Then, upon going to the opthamologist, I was diagnosed with blepharitis and dry eyes, so have been lid-scrubbing twice a day and using artificial tears up to 6 times a day, as well as not wearing contacts - excpet when I have auditions, and then I only wear them for a few hours. My symptoms still didn't subside at all, so I went back to the optomologist again, who was very vague about what he thought I had. I had said that my eyelids were swollen most of the time, and that I really didn't think my eyes were the problem, but my eyelids - which he agreed with, and said that the underside of my lids were bumpy, and that that was causing the irritation (it wasn't until I search through the internet and found your blog that I thought it was most probably GPC). He prescibed me with more artificial tears, doxycycline for eyelid inflammation and Patanol - which he told me to use before and after using contacts. Since finding your blog, I have started using the Patanol 2 times a day regardless of contact-lens wear, and there is some improvement, but not masses. It has been a week now - do you recommend I request steroid drops, or wait a little longer to see if it goes? I am in the UK, so don't think we have Lotemax here - are you aware if there's an as effective alternative? From reading other people's posts, it doesn't seem likre mine is as aggressive as others, but it certainly isn't going away, and my eyes are always at least a little bit red and irritated, and can't tolerate lenses for more than a few hours, and then the following day will feel much more irritated and red.

    Because of this, I have booked in to have ICL (intraocular treatment) for my near-sightedness. I wasn't suitable for Lasik, but they have said I am perfectly fine for the ICL. I get it in January, and am planning on not wearing contacts for the 2 week period I have off from acting. Do you think this will be long enough for my GPC symptoms to go whilst using Patanol? Or should I push for the steroids? I am aware of the risks of steroids though., so am slightly anxious... The optometrists at the laser surgery said I am completely suitable for ICL, but that the bumby lids may be irritated somewhat by the incision they have to make to get the lens in during the operation. Do you think this will be the case? I am still going to go ahead with the treatment, as am sick of not being able to wear contacts, but am keen to get rid of GPC symptoms before the operation, so as to avoid even further irritation!

    Sorry for such a long message, and I look forward to hearing your response.

    Many thanks,

    Gina

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  121. Princeidoc, I have read the whole thread here, and I get your mantra of steroids and dailies. I still have a few questions. I am 45, did not have to wear any correction until the age of 44, and have a presbyopia with a very mild prescription. (+1.25 L, +1R) I tried 30-day multifocals and had no trouble until my seasonal allergies kicked in. Suddenly: GPC, mild to moderate. My doctor put me on OTC allergy drops and ordered a trial set of dailies. I did not, however, get steroids, or instructions to keep contacts out for weeks, until the GPC clears up.

    I wore the new dailies for 2 days with no trouble, but by the end of the 3rd day, my eyes were dry-feeling and the contacts felt sticky. I saw the doctor again yesterday, and she prescribed Pataday. I am wearing glasses now, and my eyes are a bit sore today. They have never been red or goopy: I just have a foreign body feeling and have to take the contacts out when I wear them. It is my understanding from reading this thread that the dailies bothered me because the GPC was not cleared up by steroids, and I had been wearing contacts as long as I could tolerate them, with only a day or two in glasses. Do you agree that I need to 1. Call the doctor and ask for Lotemax, and 2. stay out of contacts for a couple of weeks before trying the dailies again. I guess I am hoping that the dailies are bothering me because I still had GPC when I started wearing them, and if I can cure them with steroids and glasses for a couple of weeks, I can wear the dailies.

    ReplyDelete
  122. Hi,
    Do you think a LASIK flap could irritate GPC. I had LASIK done one week ago and the eye that always gave me problems with contacts is now blurrier then the other eye and feel just like the discomfort I had with contacts. It's probably been 10 years now that I can't wear contacts for more then the couple hours before my right eye starts feeling irritated and get blurry. I spent 6 months seeing an eye doctor and being on and off steriods but I really never had gotten a diagnosis.

    I went back to the LASIK center today and he said my flap and everything looks great. He checked under my top eyelid and asked if I had allergies because the papillae looked a little inflamed. I told him I normally do but it's past the spring when they are normally bad. I had him compare it to my good eye and he said the papillae are bigger in the bad eye. He put me on prednisolone twice a day for a week and scheduled a follow up. He never mentioned GPC but now I wonder if that hasn't been my issue all along with contacts previously. I thought it was maybe dry eye before but it never helped when I was putting wetting drops in constantly. After the LASIK I have been using them every 30 mins and I don't notice any improvement when using them.

    If it is GPC what am I in for now that I already had the surgery done? Will the flap continue to irritate it or will it heal smooth enough for it to stop?

    Thanks!
    Dan

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  123. no, it's not the LASIK flap that's the problem. it's allergies and maybe dryness. and if you're still in contacts (difficult to tell from your comments) then it's the contacts too. try dailies (if still in contacts) and Lotemax (not pred).

    ReplyDelete
  124. Among many other things, my optometrist recommended I use Bausch and Lomb saline eye wash. It is a bottle of eye wash solution and a little cup.

    Do you think this is worth it? How do I use it? Do I just fill up the cup and dump it in my eye?

    I am yet to find a video online of how to do this.

    Thanks!

    ReplyDelete
  125. Thank you for this post and informative comments. I was diagnosed with GPC three years ago and have had a handful of recurrences despite having not worn contacts since diagnosis. Each time I read this post I learn something new. I'd love to know if you believe we will someday have a cure for those of us with chronic GPC?

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  126. Hi Doc,
    About two years ago, My contacts randomly started to both me and I was diagnosed with GPC. I stopped contact lenses for a while, when I would put them in it would bother me and left eye would become inflamed . I decided to see another ophthalmologist who put me on lotemax (my problem was that as long as I stay out of CLs Im ok) but when I put them in, my left eye would really bother me and makeup made it worse! ....so after using Lotemax and staying out of it for some weeks ..i went back for a follow up..he said "ok you can slowly put your contacts back in (I also switched to dailies)..he said use lotemax before and after ..so i did that..and my eyes were much better.but i never really went back to being a regular user... I only wore contacts to go to an event for a couple hours at a time.... so for a year now ive just been about only wearing contact lenses to go out
    about a month ago, I decided to start trying wearing them every day again
    i wore it for one work day. then the next day again and it was becoming VERY uncomfortable in the left eye by that point...so I took them off and let my eyes rest for a week..
    my question is
    1. Why does it continuously bother my left eye? was it something like a GPC that never got resolved from before? did it happen again?
    After about a week of staying out, I asked the ophthalmologist I work for to take a look
    she flipped my lids and said "im seeing some sort of allergic component..it could be two things.. seasonal allergies or contacts rubbing up on ure eyelids..perhaps checking the fit (that was not not it,,because the fit of my CLS was ok I had them checked) .
    she said "try putting in alrex and pataday"
    I asked her about CRT lenses. I said since contacts seem to give me a hard time, I was wondering if I would be a good candidate for CRT. She said I think those would be a good option for you because crts are smaller so they don't rub against your eyelids like the normal contacts

    A week later (WITHOUT WEARING ANY CONTACTS) one day my left eye was bothering me again...i wore makeup (itchiness redness became worse) I went to the optometrist who said ..chalazion...do warm compresses and lid scrubs..he dint feel it was big enough to prescribe anythign
    Then I went back and saw the optometrist I work for to discuss CRT lenses. She prescribed Erythromycin twice a day, advised warm compresses and lid scrubs,, and they all said I also have myobian gland plugging, and blepharitis
    i also have a chronic hz of dry eyes

    so now a week later of warm compresses, lid scrubs, erythro twice a day, and alrex once a day
    MY left eye is STILLL bothering me

    I got to see another opth. who said " i dont see a chalazion" ....ok bleph has gotten better , still mildly there,,, he said myobian gland plugging,,, then he flips left lid and said "oh yea thats a GPC" ..he said try to get ophth. to prescribe you lotemax 4-5 times per day.. otherwise if you are using alrex bump it up to twice a day

    so for the past week I have been doing Alrex Twice a day, pataday once a day, warm compresses, lid scrubs
    I decided to stick with Alrex cuz thats what the ophthomologist had said..so she must have recmmended that for a reason
    what I was wondering is she didnt say anything about GPC..but she did say "allergy component"

    Question.
    1. Alrex is a suitable treatment for GPC,and allergic comp yes?
    2. do you think I would benegit from CRT lenses. do they work well with people who have GPC ..since i know GPC is an allergy to a foreign substance like contact lenses. ....the optom said..the main problem is with blinking..so CRT would be ok for GPC
    3. do you think CRT lenses are a good option for me? and does my treatment method seem ok with alrex BID and pataday QD, using AT 3-4 times a day, warm compresses and lid scrubs?

    I am sooo confused by hearing all these diff things.

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  127. Questions like these are too much for this setting. Too long of a story and I can't really respond to all that. Very sorry!

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  128. If this blog is still going I had a question:

    Diagnosed with GPC in December. Been on a mix of Lotemax (intermittently), Bepreve, and Pataday ever since. After 3 months of no contacts was switched to daily use lens. Wore them 3 hours first day to ease into them and this felt fine but the next day itching/crusty eyes were back. So was the GPC.

    I have -11.5 prescription in both eyes so wearing glasses is very uncomfortable and inconvenient. I'm looking to get back to contacts as soon as possible but don't know what more can be done. Neither does my eye doctor. Any thoughts?

    Thank you!

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  129. yes this blog is still going strong!
    if you're in dailies and steroids and antihistamines...yes that's all you can do. that's max therapy right there. if you can't comfortably wear contacts using steroids and dailies then you likely never will. you said you had used Lotemax "intermittently"...why not chronically? Lotemax is very safe, quite a bit safer than prednisolone or FML, etc. why not try Lotemax and dailies concurrently? That'd be my "next step".

    good luck. these are tough cases. can't have LASIK, glasses are heavy and unsightly, and now GPC makes wearing contacts uncomfortable... it's tough

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  130. Thank you for your response Michael! Yeah it's been a frustrating situation, had 12 years of no problems with contacts until recently. The no LASIK is a huge bummer too. Doc had said Lotemax can cause glaucoma if used too much but I haven't asked him about using it concurrently with dailies--I'll run that by him at my next visit.

    Thank you again! It's nice to find this blog and know that I'm not alone in dealing with this

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  131. everyone is scared of steroids and uses them sparingly b/c we all know that prednisolone causes major problems (glaucoma and cataracts) if you're on it a long time. Lotemax is much, much safer b/c it is a different type of steroid that is not absorbed by the cornea nearly as well. AFAIK there is still not one documented case of Lotemax causing cataracts. I have had Lotemax raise the pressure in one patient, but the VAST MAJORITY of people are fine to be on it long term. just ask your doc if you can try it concurrently with dailies and have them occasionally monitor the pressure. I really don't think it's that big of a deal. if the pressure goes it, it's easy to stop. why avoid a therapy that might work just b/c the doc is scared you "might" get a raise in pressure? admittedly I'm more aggressive than a lot of docs out there. I don't see much downside if the doc is checking the pressure every once in awhile. it's at least worth a shot IMO

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  132. I would love to get your opinion on my situation. Back in early january I stopped wearing contacts due to movement of the lens when I blinked. I went to my optometrist and sure enough it was GPC. I was told to stop wearing my contacts (Air Optix:Aqua) for 4 weeks and use FML forte 4 times in each eye for a week then taper off for 3 weeks. At my follow up appointment a month later I was then told I could try and resume contact wear. I had them in for 3 hours and the papilla on my left eye returned almost as bad as they were initially. I made another appointment and was then given Pred Forte 1% and told to apply 4 times a day for a week and then taper off for 3 weeks. I am just now finishing this prescription and I lifted my left eye and there are still some, however not nearly as many, enlarged papilla on my top eyelid. I do not know where to go from here. My follow up is april 1st. My doctor said he would put me in dailies this time and go from there. Even though there are still some enlarged papilla on my eyelid should I continue with this plan or is there something else worth trying? Ester based steroid? Thank you for all the advice you give to people.

    ReplyDelete
    Replies
    1. Yep: dailies and Lotemax. I tell people to stop messing around with prednisone, FML and dexamathasone. IMO those do not work very well for this.

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    2. Thank you so much for your reply! It means a lot to me. Would you recommend concurrent use of the dailies and lotemax? Or is it better to use lotemax first then try dailies after a completed prescription of lotemax?

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    3. Depends on the severity of the GPC and how aggressive you and the doc feel like being. Also how uncomfortable the contacts are. I'm ok wth concurrent usage but a lot of docs are not. Besides... A lot of these end up being chronic and they can't comfortably West contacts ever again unless they're doing the concurrent use thing.

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    4. Thank you so much. Your advice means a lot to me. I just got back from my appointment and the doc is going to have me to lotemax gel and pataday twice a day for 2 weeks and then he wants to see me again to possibly fit me in dailies. I hope this will finally clear this up. What are your thoughts on this plan?

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  133. Question - about a year and a half ago, after a long day of computer work, I noticed that my eyes were really red. I immediately took out my contacts and went to sleep. The problem didn't go away; it actually got worse. So I went to many different eye institutes--including MEEI--and they all said that I had GPC. I stopped wearing my contacts completely, but my eyes are still red and hurt. Not nearly as bad as when it first happened, mind you, but they still do look very red. Some days are better than others, but it never fully goes away.

    So, I guess my question is this -- is it possible that some types of GPC never go away, even after the contacts are gone?

    ReplyDelete
    Replies
    1. YES. it can be debated that the "real" problem may be severe ocular allergy thatb the contacts just "exacerbated", but yes having the bumps/GPC be chronic absolutely happens. if the eyes are "still red and hurt", then you probably need Lotemax. IMO, anyway

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  134. Question: I was diagnosed with GPC about 8 months ago. I was prescribed Tobradex eye drops which I used for about a month, and did not wear my contacts for that time. Went back to my doctor and there was no change in my condition. Since then I have had my contacts out for about 6 months, I put them in the other night for a couple of hours, my eyes eventually started tearing and felt like there was sand in my eyes when i took them out. I would like to try using daily wear like you suggest, but I wear multi focal lenses. Do they make daily wear in multi focal, and if so, can you recommend a brand/product?

    ReplyDelete
    Replies
    1. Yep Dailes Aqua Comfort Plus Multifocal from Alcon. And I personally don't like tobradex for GPC - don't need the antibiotic so you're promoting resistance, and dexamathasone is risky for glaucoma (in steroid responders)

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  135. Is it just leaving your contacts out that works on GPC, or does medication help? If so, what medication to you recommend for GPC, in your opinion?

    ReplyDelete
    Replies
    1. "just leaving the contact out" only works until you put them back in. It's almost never a long term solution. A lot of people and docs think you can just take a break for a few days and it will go away, which is almost never true. It's almost always chronic. There usually has to be some permanent change, like dailies or lasik. Yes the medication I like best for this is LOTEMAX. not pred forte, not FML, not dexamathasone, not durezol, not pataday, etc etc

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  136. ...Continue from May 25th post...Thanks for your reply.
    I picked up my Dailies Alcon Multi-focal today, and will give them a try starting tomorrow. As I read your blog, I see people talking about toric. I did not know what that meant until I picked up my contacts today, and realize toric meant (astigmatism), and that's what mine are. I'm wondering if they are going to be to thick?

    My prescription is...
    Right Eye: Sphere -2.00, Cylinder -0.50, Axis 90
    Left Eye: Sphere -2.25, Cylinder -0.50, Axis 90

    He has me wearing the same in both eyes...
    Multi-focal
    PWR -2.50 HI
    MAX ADD +2.50

    ReplyDelete
    Replies
    1. Those are not toric lenses for astigmatism. That top one is a glasses rx and the bottom one is a Multifocal Rx.

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  137. Hello - I was just diagnosed with GPC - moderate in severity. I am prescribed to Zylet and Pataday. I've been a daily contact wearer for a few years now (Acuvue 1-Day Moist). Is this an appropriate brand/style for a GPC sufferer?

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  138. Hi doc, I did read all of the comments in this section, just a quick question:

    What is the daily contact lens you think it's best for a GPC patient
    -without Astigmatism?
    -with Astigmatism?

    with the majority of the new models in hydrogel, it became a very difficult tasks to find the best NON hydrogel dailies especially if you are not an expert on lenses' materials... For example, you did suggest Acuvue 1 day moist for a gpc patient, but aren't them hydrogel lenses? This is really confusing... :)

    I'm -4.00 with -0.75 astigmatism in both eye... I would like to know what is the best dailies for me and for people in my situation... or at least I would like to know the best contact lenses that are NOT made in silicone hydrogel

    Thanks :)

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  139. so yes I agree it's all confusing. every soft lens is a "hydrogel". that's why I try to avoid using that word. AV 1 Day moist is a "hydrogel"...but not a SILICONE hydrogel. it's plastic. basically don't go by the word "hydrogel".

    for non-astigmats I like Dailies Total One and Dailies Aqua Comfort Plus, both by Alcon. DT1 *is* a silicone hydrogel! but it's not like others. it's the newest iteration of silicone and it is literally different than all other previous silicone lenses. it's VERY, VERY slick. the slickest lens ever made. DACP is a plastic lens.

    for astigmats I like Dailies Aqua Comfort Plus Toric.

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  140. Hey Doc,

    Just wanted to know what your thoughts were on BioTrue One Day contacts as compared to Dailies AquaComfort Plus? Is there a significant difference in GPC reoccurrence between these lenses? Reason I ask is because I'm currently using BioTrue and my eyes are 'fine' but I want to see if they can be even better with the Dailies. Thanks for your feedback!

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  141. "Just wanted to know what your thoughts were on BioTrue One Day contacts as compared to Dailies AquaComfort Plus?"

    Comparable. very, very similar lenses. You probably would not be "even better" with dailies aqua comfort plus. You'd probably be the same.

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  142. Appreciate the response. I did do some research online and noticed the price difference between the two lenses is huge. I may land up switching to DACP anyway haha. I really appreciate this blog you have here. Lots of good information. Thanks again!

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  143. Hi Doctor,

    I started having itchy, red eyes in June of this year, and wore my contacts on and off until a doctor diagnosed me with GPC in early September. I went off contact lenses completely and used prednisolone 4x a day for 1 week, then 3x a day for 1 week, 2x a day for 1 week, then 1x a day for 1 week. Since stopping the steroid drops, it has been almost one month without wearing lenses. The underside of my eyelids do not look bumpy at all, but it feels uncomfortable still when I put my lenses in for a few minutes. When do you think I can resume wearing contacts? I normally use Acuvue Oasys 2-week disposables, and I have astigmatism.

    Thank you,
    Valerie

    ReplyDelete
    Replies
    1. whenever. right now! GPC is not dangerous. it's just uncomfortable. ok what you're really asking is: "am I cured from the GPC by using the pred (UNLIKELY) and will my same silicone astigmatism lenses I used to use be okay (UNLIKELY) and if not what can I do (LOTEMAX INSTEAD OF PRED AND SWITCH TO DAILIES INSTEAD OF SILICONE 2-WEEK ACUVUES)

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  144. Hey Dr. Prince I would love to get your advice. I have been out of contacts for 13 months and have seen relatively little improvement in my GPC after trying several courses of various steroids (lotemax, pred, fml forte) and pataday. I have tried to wear the same brand lenses (air optix: aqua) as I always have several times in the past year with little to no success. It seemed like every time I would blink the lense would move and it would be uncomfortable. I recently went in to get my glasses prescription checked and the optometrist there said he wants to try dailies to see if that will still be an issue. What are your thoughts on this? Do you think it is worth trying a pair of very thin and smooth daily lenses? If so, what would be your absolute favorite brand and lense type for someone who has an issue where the papilla seem to drag the lense off the eye?

    ReplyDelete
    Replies
    1. yes dailies. this happens all the time. VERY OFTEN a person with chronic GPC can never wear silicone lenses like air optix EVER AGAIN. for many of them dailies is THE ONLY way to ever wear contacts again. so yes: dailies. there are plenty of good brands but my personal fav is Alcon Dailies Aqua Comfort Plus. good luck!

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