- 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:
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.