GPC, Dailies, Silicone and "Dry Eye"

There was a new comment on one of my old GPC posts that I want to address. If you read this blog and all of the comments you'll probably figure out a few of my biases, namely: 1) GPC is often mis-diagnosed. It is my opinion that VERY FEW contact lens wearers in their 20's & 30's have "dry eye". I don't know, I could be wrong here, but I hear and see docs all over telling these 25 year old contact lens wearers that their contact lens discomfort is from "dry eye". I just personally consider that doubtful. They switch a contact lens wearer from the old Acuvue 2's to a silicone lens like Air Optix Aqua, and a few months later (usually in the Spring...) the patient starts having comfort issues and the doc announces that it's "dry eye" and recommends artificial tears. I just want to say "really?". 2) I think GPC should be treated with Lotemax and dailies. Lotemax and dailies, Lotemax and dailies, Lotemax and dailies. I'm a broken record. I've said it hundreds of times and put it on my blog dozens of times. Not Tobradex, not FML, not Pred Forte, and certainly not tobramycin and gentamycin. I think sometimes even when these docs get the diagnosis CORRECT, they often fart around with 2 weeks of Tobradex and then let the patient go back to wearing their same old monthly silicone contact lens. I just don't get that. Hey at least they're not announcing it's "pink eye" and telling the patient to throw away all their makeup, so that's a start. But I see them blaming the solution and messing around with switching to different solutions. If it really is GPC, that won't work. You have to reduce the interaction between the stiff edge of the lens and the backside of the eyelid, and you do that by picking a "floppier" (lower modulus) lens, not by treating it as "dry eye" or changing the stuff you're storing them in...and dailies (plastic dailies, anyway) are the lowest modulus you can get right now. I think low-Dk lenses get a bad rap sometimes. The Dk would probably not be a problem if the patients wouldn't sleep in them. That's partially our fault (as a profession) b/c in the 80's we announced that "extended wear" was perfectly safe and the FDA approved Avuvues and the like for "extended wear", and once a lens gets approved for something, it's not getting "un-approved". Heck I think even the old polymacon and it's Dk of 9 or whatever is technically FDA approved for EW. Patients still argue with me that Acuvue 2 is safe for extended wear b/c it's FDA approved for it. Well...yeah, it is. Should it be? I mean I personally don't think so...not with our 2012 knowledge of corneal physiology. All of us OD's assume that patients are sleeping in them, and the studies confirm it. So we're all Rx'ing *mostly* silicone lenses b/c we think they're safer to sleep in. But one of the big problems is...silicone is stiff (high modulus). Some are stiffer than others, but they're all relatively (as compared to soft plastic lenses) stiff. Well stiff lenses cause GPC in patients who have seasonal ocular allergy. So the answer in GPC management is usually..."gotta get out of silicone". The new thing in our profession is silicone dailies. Maybe later I'll be on board with this, but I just don't see the point yet. No patient wearing daily disposable lenses is sleeping in them, or at least very few. So does a patient who is never going to sleep in their lens need SILICONE? I personally don't think so. And at least for me, the reason I'm usually Rx'ing dailies is to either manage or prevent GPC. So if I think the patient has "gotta get out of silicone", I am not going to Rx a SILICONE daily. It just seems counterproductive to me, maybe I'll change my mind later. If I have a 23 year old healthy contact lens wearer in the chair who is wearing silicone lenses and complaining of contact lens discomfort, GPC is way up there on my list of possibilities & probable diagnoses. "Dry eye" is not. Not to say that it "can't" be dry eye, I'm just not figuring that's very likely. I'm going to look at the backside of their eyelids and if they have bumps, I'm going with Lotemax and (plastic) dailies. I am not Rx'ing 2 weeks of Tobradex or announcing they have "dry eye" and switching contact lens solutions (while they continue to wear their monthly silicone lens). I know where I practice: a college town (Sam Houston State Universiry - EAT 'EM UP KATS!) in East Texas where the pollen, dust and mold are all at various times ridiculously high. It just seems way more likely to me for a SHSU student with contact lens discomfort to have GPC/allergic conjunctivitis than for them to have "dry eye".

Comments

  1. Thank you-my previous eye doctor had me about ready to ditch contacts and go to glasses even though I despise them. I went through so many silicone hydrogel trials and felt like I was just being difficult because none of them seemed to help anything. I had a hard time believing dry eye would cause my eye sight to go from good to blurry and hazy with lots of deposits on my lenses in a few weeks, but I was no doctor, so I went along with the "trials". I am now fixing to trial the Soflens and hope it gets better. Thanks again!

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  2. I have another question for you, I am starting today on a 10 day trial of soflens, however I have a six month supply of the Air Optix left, and thought about trying to use them during the winter. Then I re-read what you wrote about GPC and kinda thought that would be a bad idea because it might cause another flare up. Am I correct in my thinking? IF I finally get some relief from the dryness and itching, I wouldn't want to do anything to risk it coming back.

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  3. haha I see your dilemma! This happens all the time: "what to do with my old supply? I spent good money on them & I don't want to 'waste' them." I hear you, and sparing wear of silicone probably won't IMMEDIATELY cause a 'flare up'. BUT! I do not recommend this. generally a known GPC patient is going to have GPC chronically, all year, all the time. it usually doesn't "come and go". it's always there, and wearing dailies just usually keeps it "subthreshold" where it's not causing a lot of problems. RARELY do I put someone in dailies and they come back next year and the GPC is *GONE*. it's still there. the patient thinks they're "cured", but they're not - we just "got around" their problem by Rx'ing them a low profile lens. dailies are expensive. LOTS of patients beg me to wear dailies during their 'bad' times of the year and "go back to" their monthlies when it's not their 'bad time'. that is not dangerous, ok? b/c GPC is not dangerous. it is not life threatening nor sight threatening. it's just SUPER ANNOYING and inconvenient. but that plan almost never works IMO. as soon as the patient wears their silicone monthlies again it's just a few days or weeks before "it's back". obviously it was always there, it was just not a problem b/c the patient was not wearing silicone. so if it were me...I know dailies are expensive and patients want to save their old lenses that they already have and have already paid for, but going back to silicone almost always causes the GPC to 'flare back up'

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  4. Thanks, that's what I was thinking!

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  5. I believe I have GPC. Since May, my eyes have been red, dry, tired, and in the morning, the upper lids look swollen, misshapen. I do wear contacts (monthly disposables one lens is a toric lens due to my astigmatism) everyday, though since June, I have not worn them much at all (only when I go running, for an hour at a time). I have tried several drops, all to no avail. My eyes don't seem to be getting any better. I had my yearly physical last week, my doctor said it did look like some sort of conjuctivitis. He prescribed me patanol, one drop in each eye AM and PM and said not to wear my contacts. I have not noticed any change at all. Should I go to my eye doctor and try to get another prescription or do I just need to wait this out and assume that the patanol and not wearing my contacts will resolve the problem with time. Is there anything else I can do for my eyes in the meantime? Worst part is the redness and heavy lid feeling periodically. Thank you for your advice. I enjoy reading your blog.

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  6. I wouldn't wait it out. i'd go to an eye doc. of course the eye doc would say that haha, but IMO few regular primary care practitioners know what is and is not "conjunctivitis", you know?

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  7. Thanks. I'll see if I can get in at my eye doctor in the next few days. Is there anything else for treatment I can do? Compresses, etc? Thanks for your advice.

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  8. nah. not really. artificial tears are never a bad idea. cold compresses (not hot)

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  9. Sorry to keep bothering you, one more question though. I have been wearing the Soflens for only two days, but after about 10 hours, they get pretty dry and uncomfortable. I don't want to give up too soon and was hoping this may just still be a side effect of the GPC and will eventually get better? I am hoping it is just my eyes adjusting to going back to the older material lens.

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  10. it will probably get better. GPC doesn't go away quickly!

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    1. Just an update, I ordered a six month supply of the Soflens Daily Disposable and am loving these now. The dryness at the end of the day stopped after day three and all is good, they are still very comfortable! Thanks again for all your help.

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  11. What is your think about homeopathic eye treatment?

    Dry Eye Cure

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    1. Generally I'm not a fan of homeopathic EYE DROPS, but I do like the eye warmers! A good way to apply heat for treating meibomian gland dysfunction

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  12. I live in a developing country and contracted a sty (first time ever) which began to eat a hole in my eyelid. My opthamologist prescribed oral antibiotics for 7 days and Tobradex cream. After 10 days he checked me out and told me to continue with the Tobradex until I used up the entire 3.5g tube. I'm still not done with the Tobradex although I am now 4 weeks in. The wound on my eyelid hasn't healed completely and I notice my far-away vision in this eye is now blurred. Please tell me this is temporary! I've decided to stop using the Tobradex. Will the wound heal and my vision return to normal??

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  13. that doesn't sound like a "sty" to me.

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    1. It started out as one and I guess it got infected. The infection is gone but I think the Tobradex is causing delayed healing and my blurred vision. In your opinion, what are my chances of regaining my former sight in that eye?

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  14. sorry but I have no idea b/c I don't know WHY you lost vision. a "sty" would not cause vision loss.

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  15. Hi you commented on my post of YA and mentioned that this might be why my contact hasn't been fitting correctly. I need to go for my yearly appointment this week anyway so I will mention this to the doctor. I did have a couple of other questions for you of you don't mind. My eye doesn't hurt at all and isn't red or anything. It doesn't even feel irritated in the slightest. I can wear the contact for a couple hours and then it's almost as if my eye waters, this is my bad allergy season and it just feels as though that tear or water or whatever it is, is between my eye and the contact. Does this seem like GPC or is it just allergies? It also doesn't happen every day maybe 3 times a week, although the past 2 days I have just elected to not use that contact and wear only one.

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  16. well, there is no way to tell based on any description you could give as to whether that is allergies or GPC. someone has to look. sorry!

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  17. Ok thanks, like I mentioned I have an appointment later in the week so I will have it looked at then. Should I wear the contacts so the doctor can see what I am talking about with the fit issue? They don't bother me for a couple of hours, which is partly why I assumed allergy issues. Can GPC be caused from something other than over wearing? I feel as though at this point in my life I am wearing contacts less than I ever have.

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  18. it's most often caused by having seasonal allergies and wearing silicone contacts. but yes, other factors can be: type of solution, extended wear, overwear, deposits

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  19. What does GPC stand for? I can't find it in the prior posts.

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  20. Speaking of Dry Eye, what is the difference between Lipiflow and IPL? I cant find the answer to this anywhere but have read things that would imply they are different.

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  21. well they're similar in that they're both expensive & obscure in-office dry eye treatments that require expensive and obscure equipment. but the "difference" is that IPL is LIGHT and lipiflow is HEAT

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    1. My eye dr tells me I have really bad dry eye. We are trying to figure out something to make it better but nothing seems to be working, except for theratears nutrition capsules. When I take these, I can seriously feel the improvement in my eyes withing 30 mins or so which seem to last a good amount of time. I'm wondering if that is because it is causing me to create, thicker/better tears?

      On top of this thought, I was pondering one day about how much my eyes were miserable and discovered something. Before I had dryness issues, I would wake up every morning with the whitish/cloudy "eye snot" in my eyes when I would blink. Since having dry eye, I have never woke up with this cloudyness. Is this cloudiness the oily layer that I am missing currently? If so, is there a way to stimulate these glands and get them to produce more oil? I have tried the hot compresses and didn't have much luck.

      Lastly, I used to remember having a tiny amount of this "eye snot" in the corners of my eyes daily--something I have no longer. Kind of the same thing with waking up with eye snot when I blinked.

      After reading all of these things on the internet and trying punctal plugs multiple times, I am beginning to think I am only producing the watery layer of the tear and not the other two so therefore my tears are of poor quality. I am going to a dry eye specialist in a couple of months but for the sake of my sanity, can you please tell me if this sounds like something that makes sense or may be logical? I am trying anything to solve this nasty puzzle I have been dealing with the last two years. Thanks!

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    2. My apologies for blowing up your comment section, but I was reading one of your prior posts from one of your prior blog posts on GPC and I came up with another question. You typed the following:

      "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."

      This is EXACTLY what happened to me...EXACTLY. So my question here is, is this a definite? Can there be ANY other issue in the world that this may result in?

      I am slightly confused because I have been told my eyes have horrible TUBTs and Theratears Nutrition has been doing wonders for my eyes. That would indicate I have dry eye syndrome since those seem like logical responses for someone with dry eyes? For someone like me who knows nothing medical other than what I read on the internet (most of which I don't understand a whole lot), originally I would say that I have dry eyes. However, your posts seem to more accurately describe my problems moreso than my eyes' response to the various "dry eye treatments" all of which have had no effect on me (except theratears). And yes, I am a college student so it does seem weird that I would have dry eye syndrome. Lastly, I noticed that it is my upper eyelids (inside part that touches my eyes) and my lower eyelids (only where my eye lashes come out of)that often feel dry/burning rather than the eyes themselves.

      Again, sorry for all of the posts and thanks for everything. I think you might finally provide me with the right path to finding relief, which is something I have been trying to do for 2 years. You have helped me so much with your posts.

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  22. " I'm wondering if that is because it is causing me to create, thicker/better tears?"

    it's thought that omega 3's change the consistency of meibomian gland excretion, yes. also the metabolism of the gland itself changes

    "Is this cloudiness the oily layer that I am missing currently?:

    that's mucous and oil, yes.

    "If so, is there a way to stimulate these glands and get them to produce more oil?"

    yeah in theory hot compresses and oral omega 3's. also oral doxycycline

    "can you please tell me if this sounds like something that makes sense or may be logical?"

    YES you're probably right on. IMO *most* dry eye is a lipid/mucous/oil problem...not an aqueous production problem

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  23. "Can there be ANY other issue in the world that this may result in?"

    probably not. sure there are other *possibilities*...all rare. (vernal conjunctivitis comes to mind...unlikely that's it tho)

    MOST college students do not have "dry eye" IMO. possible? yes. LIKELY? no. not likely. way more likely to be GPC in this case. IMO a LOT of docs rely on "dry eye" as their kind of fall-back, catch-all diagnosis. if they don't know what it is, they say it's "dry eye". sometimes they're right...

    "burning" eyelid margins sounds like "blepharitis"...an eyelid inflammation. wouldn't hurt to try some OTC "lid scrubs". Ocusoft and Alcon make some, they'll be in the eye care section of the pharmacy

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    1. So in response to your last two posts, is it possible that someone could have GPC as their main problem, which would lead to inflammation resulting in the oil not having the ability to secret oil thus resulting in dry eyes? Perhaps I have had GPC the last two years and so my eyes are so inflammed that proper tears cannot get through?

      In other words, can GPC and Dry Eye ever work off of each other and aggravate the symptoms on the other one? Thanks!

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  24. umm...well really who knows? possible...yes. I am more inclined to think they're somewhat unrelated...

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  25. Hi! I had a few questions regarding some of the prior posts:

    1. Are allergies necessary for one to get GPC or can it simply be some bacteria gets put into the eye as one inserts his/her contact?

    2. Do people with GPC complain that they have burning eye lids (specifically the eyelids)?

    3. I know that you have mentioned this isn't vision or life threatening but is it harder to treat if you let it go for a longer amount of time?

    4. Would fish oil help with this by reducing the swelling/flare up?

    5. Are these bumps only present on upper eyelids or can they form on the lower ones as well?

    Thanks for all of your advice and knowledge!

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  26. 1) yes allergies are part of the GPC sequelae. They have nothing to do with "bacteria". strictly inflammatory

    2) this is tough. the short version is "yes". The longer version is...the description for patients on *exactly* what something feels like varies widely and is not very accurate nor reliable. what "burns" vs what "itches" vs what is a "twinge" or an "ache" etc etc etc is a really gray area. most of the time "burning" eyelids is attributed to BLEPHARITIS, not GPC. but often (today even) a patient with raging GPC told me their lids "burned".

    3) the worse it gets, thet longer it takes to get over, yes.

    4) no, fish oil probably will not help if it really is GPC

    5) can be present on upper & lower

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  27. I don't know if I have GPC or not. I am told it is dry eye but since all dry eye treatments have no positive result and I'm only 21, I am beginning to think the eye doctors were wrong...not to mention the fact that one day, my contacts that I have been wearing forever (forever meaning 8 years) moved every time I blinked.

    So I went to the school eye doc to find out why my contacts weren't working right. I tried ALL contacts that are daily wear and have found that the only ones that dont move when I blink are AcuvueTrueyes and Acuvue Daily Moist.

    Is it normal for someone with GPC to find themself trying on contacts and finding that "hardly any seem to fit". Also, should I try to switch to the Acuvue Moists in your opinion, since I saw that Trueyes were your least favorite? Is there a significant difference between Moist and Trueye?

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  28. This comment has been removed by the author.

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  29. yes this sounds like a typical GPC case. FEW 21 yr olds are "dry". I mean it happens but it's rare IMO. and like I always say: if you were cruising along wearing the same brand and the same size and everything was all fine...then one day BAM! your contacts "slide around" or "don't fit"...that's screaming GPC.

    so...yeah it sure sounds like GPC. next time instead of them sitting there with you trying in dozens of lenses...someone needs to actually look at the backside of your eyelids.

    the big difference between trueue and moist s...trueye is silicone, moist is plastic.

    IMO every GPC sufferer probably needs plastic, and probably needs to AVOID silicone. I never, ever Rx any silicone lens, even trueye, in a patient with GPC

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  30. Is it typical for GPC patients to have increasing discomfort as the day goes on due to the person blinking/causing friction between the eyelid and eye throughout the entire day?

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  31. Sure that's possible, but I would not say that exact symptom is "typical"

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  32. A couple of questions for you:

    Is Pred Mild something that can be used to treat GPC?

    Also, I tried looking on Google images to try to see if this is what I have going on. (I would just go see my eye doc but I am in a foreign country so I don't have that option). I assume the images found on google will most likely be really severe cases, not to mention the fact they are magnified. So my question is this, will I be able to tell if I have GPC or is it something the average person cannot see unless of course it is really severe?

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  33. yes PM has been used to treat GPC. not by me, but by others...especially in the past when there wasn't much out there (and lotemax wasn't avail).

    "will I be able to tell if I have GPC or is it something the average person cannot see unless of course it is really severe?"

    it is something NO ONE can see w/o everting your eyelids. and the average patient/doctor is not going to know what it looks like.

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  34. If GPC goes undetected/incorrectly diagnosed, is it something that can make someone's eyes irritated day in and day out for 2 straight years?

    If so, how do bumps on the eyelids lead to red, irritated eyes? Random question I know but just wondering. Thank you!

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  35. Yes and yes

    And that is not random at all! Perfectly valid question

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  36. Hello,
    Very interesting post. I wanted to know if using an ointment like Refresh PM would be detrimental to the melbomian glands or anything in the eye when used long term. Thank you!

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  37. So if this is something that directly affects the eyelids, is there a known explanation for why/how this would irritate our eyes?

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  38. haha yes...there's a contact lens rubbing your eye, being dragged around excessively by the bumps on the backside of the eyelids...

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  39. (In response to your last answer) I have read that GPC is something that doesn't really ever go away a lot of times. So let's say someone has GPC and decides to go 1 year without contacts and finds his eyes are red everyday/itchy/foreign body sensation etc. Is there another reason for these symptoms to persists since contacts in this hypothetical case are not rubbing against the eye? Can the bumps rubbing the eye without contacts be enough to irritate the eyes?

    Basically, I feel like I have GPC based on the previous comments but I wonder if there is something else going on in addition to GPC. I am young and probably don't have dry eye based on all dry eye treatments having no effect. Also, I have no seasonal allergies or any of that fun stuff. My eyelids burn/sting like crazy and my eyes are often red.

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  40. "So let's say someone has GPC and decides to go 1 year without contacts and finds his eyes are red everyday/itchy/foreign body sensation etc. Is there another reason for these symptoms to persists since contacts in this hypothetical case are not rubbing against the eye?"

    yes: ALLERGIES.

    "Can the bumps rubbing the eye without contacts be enough to irritate the eyes?"

    yes

    "burning" and "stinging" are usually more associated with dry eye and BLEPHARITIS than they are allergies

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  41. hey, so you say GPC will NEVER go away, it will only reduce?

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  42. it can go away...if you completely remove the allergic factor. usually that means totally ceasing contact lens wear or moving to a place where whatever it is you're allergic to doesn't bloom

    but if you can't move and you can't stop wearing contacts...it usually hangs around to some extent

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  43. Is there a chance that Restasis can irritate GPC and make the condition worse? (I know that Restasis isn't used to treat GPC but I am just asking in the instance where someone would have dry eye AND GPC)

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  44. IMO it is improbable/unlikely that Restasis would *worsen* GPC. Restasis has anti-inflammatory properties. I doubt it would *help* GPC much, but it won't hurt it, either

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  45. If someone didn't use any sort of a medication/eye drop, how long would they have to stop wearing contacts in order to have GPC reduce to a level where they could resume wearing contacts?

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  46. ah it's not as simple and cut & dried as that. too many factors:

    1) how severe is the GPC?
    2) how robust is the person's immune response?
    3) what allergens are present and how severe is the patient's reaction to them?
    4) what kind of contact lenses are we talking about here? dailies? or say high-minus and high-cyl soft vial non-disposables

    etc etc etc.

    but MOST of the time for MOST people...if the ONLY disontinued CL wear and nothing else changed...say 3 months? a long time. not "a couple of days", which is obviously what most heavy contact lens wearers are hoping to hear.

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  47. Hi there, I've had gpc for about years but only on one eye, the other is barley noticable when my doc flipped the eyelids but my case is a bit different since I was poked in the eye on accident, wasnt so bad but I was thinking that it led to slight eye dryness and the fact that I was still wearing contacts after the incident caused the gpc to flare up, as of right now my eyelid is puffy. I know you get asked the same questions often but the doc says my gpc is not even 'Giant' yet so would alrex cure it and also reduce the eyelid puffiness back to normal size? thanks so much for your input !

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  48. "my case is a bit different since I was poked in the eye on accident, wasnt so bad but I was thinking that it led to slight eye dryness and the fact that I was still wearing contacts after the incident caused the gpc to flare up"

    GPC is a chronic thing. *usually* a "one time event" like getting poked doesn't cause GPC or cause it to get worse.

    "would alrex cure it and also reduce the eyelid puffiness back to normal size?"

    if you still have allergies and continue to wear contacts, it is unlikely that anything or anyone will "cure" your GPC. so I wouldn't use the word "cure". but yes, Alrex is a steroid and steroids are used to treat inflammations and GPC is an inflammation...so yes this is probably an acceptable therapy. I don't use Alrex much b/c it's half the concentration of lotemax. usually by the time the patient gets to me (after weeks/months of just suffering, or incorrect diagnoses/treatments) they're past what Alrex can do and they need the double-concentration lotemax

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  49. Princeidoc,
    I can't tell you how happy I am that I found your website. I have had GPC for over 2 years. I have been on Patanol for those entire 2 years and have made numerous appts with my eye doc, who never seems to have any answers as to why this won't go away. I am definitely going to ask him about Lotemax.....but do you think it is too late for me? I have a feelign I'm just doomed forever with this thing.

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  50. I also wanted to know, can I wear eye makeup while using Lotemax?

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  51. haha I'm sorry! no there really isn't such a thing as "too late". there are cases that don't respond well, but TIME doesn't have much to do with it IMO.

    dailies & Lotemax. Lotemax & dailies. :D
    get out of silicone

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    1. So happy I found your blog! I stopped wearing CL 4.5 years ago b/c my eyes could no longer tolerate them (never once diagnosed w/ GPC). Back in Feb, I was diagnosed with Blepharitis, and a few months after that, my eyelids started drooping. I went to a plastic surgeon for my droopy eyelids, and he told me that drooping had nothing to do with blephrts. He flipped my eyelids and told me I had GPC. I haven't worn CL in almost 5 years! He prescribed steroid drop, but allergist sd no b/c of associated risks. Two questions: (1) would GPC show up 5 years after stopping CL? (2) If I were to use steroid drops, wouldn't my lids droop again when I stopped b/c steroids can't be used forever?

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  52. Hello there,
    I'm a 20 female student who plays sport on a regular basis weekly thus being told lenses is not an option at the moment due to suspicions of contact wear GPC was a huge thing for me. I hate glasses, have always hated glasses on me and still feel extremely limited to what I can do without my lenses
    I have been off my lenses for over 3months now as requested by my opthamologist. And I've been using VIVIDRIN preservative free eye drops 4 times daily. I don't see any real improvement at all, as I did try to wear my contact lenses which are 2 weekly acuvue soft lenses recently and within 2 hours my eyes are extremely red- they look as if I've had a good long cry and my eyes are irritated looking and ultimately the lense uncomfortable. Prior to this suddenly happening I had been away on holidays and yes I had my lenses in for too many hours per day. But I have always been able to comfortably wear these lenses. I have normal IgE levels and a schmirer test taken by my opthamologist suggests I have normal tear production. However 2 months previous when the initial discomfort after holidays began, I went to an opticians who said my tear break up time was 3-4 seconds and my eyes felt incredible dry which was my main concern. My eyes are less dry now as I use clinitas soothe which feels like heaven in my eyes. To describe what happens when I put in my lenses recently after being off them for 3 months may be beneficial- my lenses feels dry when I immediately place it on my eye, shortly after there's like a formation of a little redness around the periphery of the lens and then an overall red appearance to my eyes. This is worsened when my eyes are tired. Without lenses my sclera is not fully clearly white always that redness but not to same extent when wearing the lenses. And I can clearly see inflamed looking internal eyelids when I evert them. My ophthalmologist is beating around the bush not really capable of diagnosing it definitively- whilst the only symptom visible to him is enlarged papillae. Surely this can only indicate GPC?? I do overall have an allergy to dust in general and I'm a sufferer of upper respiratory tract infections which is out to bay with the use of a nasal rinse.

    I would greatly appreciate any information you have. Do I have GPC? And basically what in your eyes is the next port of call in regards to treatment?

    Many thanks

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  53. 1) yes but if that's the case it's probably not contact-lens related. probably strictly allergy related
    2) don't know if your lids would droop again when you stopped. while it is true that traditionally steroids were short term therapy b/c of long term risk...Lotemax has proven to be safe so far for long term therapy...

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  54. Hello there,
    I'm a 20 female student who plays sport on a regular basis weekly thus being told lenses is not an option at the moment due to suspicions of contact wear GPC was a huge thing for me. I hate glasses, have always hated glasses on me and still feel extremely limited to what I can do without my lenses
    I have been off my lenses for over 3months now as requested by my opthamologist. And I've been using VIVIDRIN preservative free eye drops 4 times daily. I don't see any real improvement at all, as I did try to wear my contact lenses which are 2 weekly acuvue soft lenses recently and within 2 hours my eyes are extremely red- they look as if I've had a good long cry and my eyes are irritated looking and ultimately the lense uncomfortable. Prior to this suddenly happening I had been away on holidays and yes I had my lenses in for too many hours per day. But I have always been able to comfortably wear these lenses. I have normal IgE levels and a schmirer test taken by my opthamologist suggests I have normal tear production. However 2 months previous when the initial discomfort after holidays began, I went to an opticians who said my tear break up time was 3-4 seconds and my eyes felt incredible dry which was my main concern. My eyes are less dry now as I use clinitas soothe which feels like heaven in my eyes. To describe what happens when I put in my lenses recently after being off them for 3 months may be beneficial- my lenses feels dry when I immediately place it on my eye, shortly after there's like a formation of a little redness around the periphery of the lens and then an overall red appearance to my eyes. This is worsened when my eyes are tired. Without lenses my sclera is not fully clearly white always that redness but not to same extent when wearing the lenses. And I can clearly see inflamed looking internal eyelids when I evert them. My ophthalmologist is beating around the bush not really capable of diagnosing it definitively- whilst the only symptom visible to him is enlarged papillae. Surely this can only indicate GPC?? I do overall have an allergy to dust in general and I'm a sufferer of upper respiratory tract infections which is out to bay with the use of a nasal rinse.

    I would greatly appreciate any information you have. Do I have GPC? And basically what in your eyes is the next port of call in regards to treatment?

    Many thanks

    ReplyDelete
  55. Sounds like GPC to me. Certainly a lot more likely than "dry eye" in a 20 yr old. Yes of course you have a "normal" schirmer. You're 20!

    As for options...Heavy artificial tears is obviously not working (ahem) so I'll go with my standard answer: steroids & dailies!

    ReplyDelete
    Replies
    1. Thanks a million! I am so lucky so have come across your blog! Great to hear similar stories and an actual solution to work with

      Cheers and Happy Christmas from Ireland

      Delete
  56. I have a question. I have GPC and have been dealing with my contacts ripping after 1 day of use (I used to use 2 week Acuvue 2 brand, and now Acuvue Oasys 2 week wear lenses) and it has been happening for about 7 years. I've wasted so much money on contacts b/c they rip either 1-5 days into wearing them. I don't have long nails, I don't sleep in them, I'm not rough w/ them so what is happening?? I've called Costco, I've called Acuvue, no one can help. I'm thinking maybe my GPC is eating the lense?? Could the allergy be eating the contact, which is why it keeps happening all the time??

    ReplyDelete
  57. it's your handling technique. you're pinching them or something. it's not the GPC. it's not allergies. it's your handling of the lenses. that's pretty much the only thing it can be.

    great time to switch to dailies since you:

    1) are ripping lenses
    2) have GPC anyway!

    ReplyDelete
  58. What treatment do you recommend for someone who has mucin layer deficient dry eye? Thank you for sharing your thoughts...it has helped me figure a couple of things out so far. I really appreciate it!

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  59. Hey great blog!

    So a few questions. Ive been struggling with dry eye for about a year now. It really seems from your descriptions i have GPC and not dry eye (25 year old healthy male). I wore contacts for about 10 years prior but never slept in them and would take them out when i got home. Then all of a sudden i went to get new lenses and they felt very uncomfortable and i couldn't wear them.

    The eye doc says my tear film is low and my schirmers score was low as well. Theyve never looked for GPC but just have given me restasis, doxy, eyedrops, and punctal plugs for the dry eye with minimal effect. Ive also had very short stints on FML and tobradex (7 days each).

    My question is would GPC lead to lower amount of tears or do i most likely have true dry eye?

    Would those 7 days tobradex and FML be enough to clear up GPC if i had it? Ive also discontinued contact lens wear and its only starting to get slightly better almost a year after the initial diagnosis.

    ReplyDelete
  60. "My question is would GPC lead to lower amount of tears"

    no

    "or do i most likely have true dry eye?"

    if you really have low tear film then that's probably dry eye

    "Would those 7 days tobradex and FML be enough to clear up GPC if i had it?"

    no. unlikely

    ReplyDelete
  61. What's wrong with using tobramycin or tobradex, as opposed to lotemax?

    ReplyDelete
  62. well tobrymycin is an antibiotic. it will never treat an inflammatory process like GPC. worthless.

    tobradex contains dexamethasone, which I don't like to use for GPC b/c most GPC patients are on it for weeks at a time and dex is notorious for causing your intraocular pressure to go up. plus tobradex contains an antibiotic...which if you know it's exclusively inflammatory, you're PROMOTING bacterial resistance by using an antibiotic for weeks at a time

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  63. thanks for your response. I currently wear two-week disposable acuvue oasis hydraclear lenses and am thinking of switching to daily disposables. is there a particular brand or type you'd recommend if i have minor GPC (my optometrist was able to see slight minor bumps when eyelids were inverted)?

    ReplyDelete
  64. Nah not really. Plastic ones. I have my preferences...I like Alcon Dailies Aqua Comfort Plus, but just about any non-silicone one will do IMO. Good luck!

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  65. I've been considering switching to dailies for awhile now. Thanks for sharing this. It really helped me weigh the pros and cons.

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  66. now there's Alcon Dailies Total 1!

    http://myeyepod.blogspot.com/2013/05/alconcibavision-dailies-total-1-game.html

    ReplyDelete
  67. What a wonderful and informative blog! I have been wearing lenses since the age of 11 (I am now 33!) and have struggled for years with constant discomfort (end of day as well as extreme burning and watering AFTER removal...). I think I have tried every contact lens out there (I am now in Acuvue TruEye...which costs an arm and a leg and is really no better for me than the others), since that seems to be my opthamologist's only idea for a solution. I am wondering if it's perhaps a case of undiagnosed GPC? Might the post-wearing irritation (it's really awful...) be a symptom of this? I plan on going back to my doctor for (what seems like) the hundredth time....but thought I would pick your brain too, since you seem so knowledgeable....

    ReplyDelete
  68. yes it's possible that GPC is a factor in your case. have them look! also...you should try Dailies Total 1 by Alcon/Ciba. I know when I posted the original entry last Aug I said: "So if I think the patient has 'gotta get out of silicone', I am not going to Rx a SILICONE daily. It just seems counterproductive to me, maybe I'll change my mind later."...well I am now changing my mind. DT1 has a very, very low surface friction, which is one of the big factors in both "dryness" and probably the main CAUSE of GPC. TruEye does *not* have a low surface friction. it has an average or maybe even HIGHER than average surface friction. that's bad IMO for both dryness and GPC, hence your statement that TruEye is really no better than anything you've had in the past, which I agree with. TruEye is nothing special IMO. DT1 *IS* something special. I really do think so. it is new and DIFFERENT, and BETTER. *NOW* I *WILL* be Rx'ing a "silicone daily".

    ReplyDelete
  69. check out this video at the 1:00 min mark. TrueEye is really no better than Oasys as far as "lubricity". DT1 smokes them both.

    https://www.youtube.com/watch?v=XwmW0tlWTMc

    ReplyDelete
    Replies
    1. Thank you for your thoughts! I will bring all of this up with my eye doctor and hopefully we will solve my problem! I detest my glasses ;-)

      Delete
    2. Me again! I went to the optometrist and he was able to rule out GPC. He is taking me out of the TruEye and putting me back in another plastic daily (I asked him about the Total 1 Dailies, and, unfortunately, they don't yet make them in my prescription. So, while it's great that I don't have GPC, that still doesn't answer why I am getting these strange burning/tearing reactions after taking out my lenses (it happens anywhere from right after to hours after....and sometimes even on the days when I don't wear my lenses at all....and lasts about 5-10 minutes). Since he didn't seem to have any ideas (nor did he seem overly concerned...), I wanted to ask if you had seen this in patients? Worth a trip to the Ophthalmologist?

      Delete
    3. well you inadvertently stumbled upon a bias of mine. so be prepared haha:

      no, a trip to the ophthalmologist probably will not help you. people have the idea that the ophthalmologist is the "better eye doctor", when in reality...they're just surgeons. I mean surgery is great...lots of people need it. I send 3+ people a day for eye surgery to an ophthalmologist. but is an ophthalmologist going to be able to figure out why you can't wear contacts comfortably? UNLIKELY. most ophthalmologists don't even have any contacts in their office. it would surprise me greatly if some ophthalmologist was able to solve your discomfort when the optometrist couldn't. just my opinion! sorry you can't have DT1 yet! good luck!

      Delete
    4. and as for "have I seen that in patients"? yes...I've seen everything. likely so has your optometrist. some people just can't fix their comfort issues. aging and long term contact lens wear along with all of the other factors (allergens, solution, lens material, wear time, eye surface dryness, meibomian gland dysfunction, etc etc etc) can just make it nearly impossible to figure out "why" some people can't get comfortable. it's very upsetting to patients, especially if/when they HAVE successfully worn lenses in the PAST...then they expect to be able to in the future...which is not always the case. all you can do is try different lenses and different solutions and different wearing schedules, etc etc...change each of the variables and see if you can come up with something that works. it's doubtful that this is come disease process that the ophthalmologist will "figure out" when the optometrist couldn't.

      Delete
    5. Thank you! I appreciate your thoughts and will continue to experiment....

      Delete
  70. I have read your thoughts regarding Lotemax vs. others (i.e. Cromolyn). Nonetheless, I am using Cromolyn and am seeing great help from it.

    I have noticed mild, mild, mild pain (emphasis on word mild) in the upper area of my eye just right under the eyebrow bone. Does Cromolyn cause an increase in eye pressure? I am also using Alaway too. It's so mild that I can hardly feel it, but my eyes aren't something I want to mess around with. I'm thinking maybe I just strained the muscles somehow?

    ReplyDelete
  71. Crolom does not cause eye pressure to go up. You can't really "strain a muscle" in your eye.

    ReplyDelete
  72. Hi Doctor,

    I am a 25 year old woman and in great health... a side from my eye irritation.

    Today, I had my sixth visit O.D. within the past year, not the same one O.D. each time. I've actually been seen by 4 different O.D.'s. Partly because I've moved a few times this year, and partly because I keep hoping to find one that won't be so wish-washy. By that I mean, the first time I noticed irritation and dryness these symptoms were quite evident and painful. I visited and O.D. and was informed that my symptoms were "a complete mystery." She told me my eyes showed some irritation and told me to clean my contacts in better solution and spend more time not wearing them. The next time I visited my symptoms had worsened. She then prescribed me a steroid and told me a could wear my contacts again in a month. My symptoms did not improve. After several months, I visited another O.D. who told me I had GPC and to use the steroid again for a few weeks and then he would put my in dailies. Instead, I decided to take the steroid and then wear glasses for the next 5 months in hopes it would speed my recover. After that time I visited another O.D. who informed me I definitely still had GPC, he suggested I continue to stay out of contacts until my symptoms subsided. He said it could take 6 months to even a year for the symptoms to get under control and he suggested some soothing natural remedies in the meantime. Finally I visited another O.D. a few months ago to check up on my GPC and update my glasses prescription. When I met with this one, she said that my eyelids looked almost completely healed and she suggested I go ahead and update my contact prescription because there was no reason why I couldn't start wearing them again. I wore the truevue contacts just one day and then decided to stick with my glasses for a while longer because at no point in the past year have my symptoms completely disappeared and it didn't want to further irritate them by wearing contacts when I hadn't gotten complete control of the symptoms while staying out of contacts. it's just that some days are better than others and overall my eyes feel a lot better than last year.

    All that said, I visited the O.D. again today because I wanted to make sure I was doing all I could and if the fact that my symptoms have hung around for a year was not unusual or cause for concern. I just don't want to hear in a few years that there was something I should have done but since I let it go I screwed my eyes.

    So today, the O.D. announced that it seems I have "dry eye" and that I will always have it and that it may be very difficult for me to Ever wear contacts again and that lasik surgery was definitely out of the question for any time in the future. SHOCK. Not a single other visit had any O.D. said that I had "dry eye" in fact when I would question all of the others on it, they believed that my dry symptoms were just from the GPC and should subside once the GPC faded. And they all said that my current condition wouldn't restrict me from being a lasik candidate... but I would need to clear it up before seeking that option.

    Needless to say, I've spent the day crying my eyes out because of the news the O.D. gave me today.

    Sir, should I seek yet another O.D. to help me in treating my condition or should I try visiting and ophthalmologist or should I just keep with treating my GPC on my own by staying out of contacts and caring for the health of my eye?

    Also, is a person who has had GPC but has "recovered" still a candidate for lasik?

    And, finally, should I seek "dry eye" treatment because the O.D. today told me I have it, or is it safe to continue to focus on waiting for my GPC to get better?

    I just want to know that I am doing everything I can and that there is hope still.

    Disheartened,

    Hannah

    ReplyDelete
  73. well, that's actually a pretty common story. I get a few of these a year, believe it or not. you're not the only one. if you're young (under say, 30 for sure) then the chances that this is TRUE clinical "dry eye" is a little unlikely IMO. plus, you have to think of the other docs...which one is the outlier? don't get too upset over what ONE doc told you, when that disagrees with that the other FIVE said.

    "should I seek yet another O.D. to help me in treating my condition or should I try visiting and ophthalmologist or should I just keep with treating my GPC on my own by staying out of contacts and caring for the health of my eye?"

    well it is my own personal opinion that most contact lens wearers need to be seeing contact lens specialists. none of those are ophthalmologists. ophthalmologists are surgeons. don't go to one until/unless you want/need surgery. whether you see another OD or keep treating on your own, etc etc...that's a tougher decision. personal preference, I guess.

    "Also, is a person who has had GPC but has "recovered" still a candidate for lasik?"

    usually.

    "And, finally, should I seek "dry eye" treatment because the O.D. today told me I have it, or is it safe to continue to focus on waiting for my GPC to get better?"

    it is certainly "safe" as far as eye health is concerned to keep focusing on getting the GPC under control.

    "I just want to know that I am doing everything I can and that there is hope still"

    there is hope. but you should know that SOME PEOPLE never get over GPC and can never comfortably wear contacts ever again. it absolutely happens...I have at least a few of these patients. it's possible.

    why not try the latest and greatest: Alcon Dailies Total 1? TruEye (the lens you most recently tried, I think) is not significantly different than any other previous product. DT1 absolutely is different.

    ReplyDelete
  74. Thank you, doctor! When I am ready to try contacts again, I will definitely look into using DT1.

    I know it is possible that I may always have GPC to the degree that I will never comfortably wear contacts. Is it also possible that it may just take me a few years to "recover" from GPC and then be able to wear good dailies and may be have lasik?

    I ask because the first few O.D.'s I went to said that my GPC would probably clear up in a few weeks after staying out of contacts (which obviously wasn't true for me which makes me feel like there is something wrong with me if it clears up within a month for others) and then one of them told me it could take 6-12 months (it will be 12 months out of contacts for me this October). Do you have any cases that have just taken several years "recover" (because I understand I may will always be prone to it and need to be careful not to have a flare up again)?

    Thank you so much for all your advice. I wish you lived in VA Beach, so I could visit your practice!

    ReplyDelete
  75. well it has been my experience that the ones who stay out of contacts for more than about 9 months and their GPC still doesn't resolve...those usually don't ever resolve. since GPC is probably peripherally related to seasonal allergies, if you make it all the way to your next "bad allergy time of year" and it doesn't get better at some point during that time...then the chances of it going away completely are slim IMO. that doesn't mean it "can't" go away, it just means I wouldn't be surprised if it didn't. *MOST* GPC cases resolve in under 6 weeks with steroids and a switch to dailies (or discontinuation of lens wear, like you). no, I don't have any cases who took "several years to recover". everything over 1 year is usually permanent. it means those people have a *hearty* immune response and can't escape their allergen. usually in East Texas the culprit is pollen, since we go years at a time w/o enough "hard freezes" to kill all the weeds, so they're year-round. don't know what the likely cause is for you in VA Beach, tho.

    GPC is not a contraindication for LASIK. in other words, you don't have to get over your GPC to have LASIK. severe dry eye, however, *IS* a strict contraindication. so if you really are "dry" (I doubt it but it's possible) then you probably cannot have LASIK. but if it's "just" GPC...no problem with LASIK.

    ReplyDelete
  76. You have given me a lot more insight than any of the other doctors I have visited and payed a lot of money! So, because you are so insightful, if you have a minute, can I run a few theories by you that I have been asking doctors about for the past year in regards to my eye?

    -August 2011: started birth control, started a new job with a lot of reading, working in dusty office, also got married, I wore a ton of new makeup-that evening I washed and washed to get it off-next morning woke up with incredible burning sensation and RED eyes. April 2012: my symptoms started as difficulty wearing contacts due to: right eye dry, blurry, irritated. May 2012: impossible to wear contacts due to above symptoms plus a new burning sensation and a reoccurring little red spot next to my pupil. Visited OD who said my symptoms were a mystery. I mentioned my work conditions, my wedding, and birth control. She said she only saw very mild irritation under my eyelid, told me to clean my contacts with better solution. I returned weeks later because my pain did not get better she prescribed me FML and told me I could wear contacts again in a few weeks. I used the drops as prescribed; however, I also stopped taking birth control pills because I was concerned it was related. July, August, September 2012: I moved, therefore, didn't have a job for months, so my eye had plenty of time to rest. Wore contacts off and on, but wore my glasses a lot more than before. September 2012: One night I was out and I wore my contacts later than usual (like 10PM), came home, my eyes were burning, took my contacts out. Contacts were dried out so much that I threw them away. Put lubricating drops in. The next week I went to see a new OD. I had done a lot of research at this point, so I asked the OD if my problems were possibly do to “GPC”, or related to my past usage of birth control or my wedding night. He said I definitely had GPC. I told him I still had FML left over, so he told me to use it for a few weeks stay out of contacts and see him in a month and he would prescribe me dailies. He said he highly doubted I had dry eye syndrome, but possibly had some seasonal allergies coinciding. I didn't go back the next month because my eyes hadn't fully recovered from GPC so I didn't want to pay for an exam for dailies that I couldn't wear yet. Since October 2012: I haven't worn contacts, I stopped wearing all make up, bought a more gentle face wash, started drinking a ton of water, started taking Zyrtec. February 2013: I saw another OD to ask how my GPC looked. He said I definitely still had it. He said sometimes people have it 6 months to a year. He didn't want to put me on steroids because he didn't think it necessary. He told me to stay out of contacts until the symptoms went away. He said my tear production was good and he had no reason to believe I had dry eye syndrome. May 2013: I returned to get an updated prescription and check on my GPC. A different OD met with me this time, she said she thought my GPC looked like it was almost completely cleared up, and even though I only came for a glasses exam, she thought I should just go ahead and get examined for dailies too and I could start wearing them immediately. June 2013: I went to see her again because I only tried to wear the contacts one day, and my eyes were dry and irritated by the end of the day. Without any additional exam, she stated I had seasonal allergies and dry eye syndrome, and that I would never be able to wear contacts again with out plugs or steroids or something.

    Possible contributions to my eye problems over the year? My theories: Birth control? GPC? Allergies to pollen, dust, make up? Damage-a burn or tear that is still healing-due to wearing contacts while my eyes were clearly unhappy? I realize a lot of symptoms are the same for a wide variety of conditions; however, if you have any insight from the above information, or if you know what maybe I should ask an OD to check out next time. I would really appreciate it!

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  77. 1-time events like your wedding night are not a factor. you cannot have irritation from makeup, etc 1 time that causes permanent damage or GPC. GPC is a result of allergies and contact lens wear. lots of allergies and lots of contact lens wear, not "my eyes were dry and irritated one time, and now I have permanent problems". can't blame your wedding night irritation for anything except the irritation the next day after your wedding night.

    Borth control: can cause dryness. is it causing YOUR dryness? who knows? can only cause dryness WHILE you are actively on it, so taking birth control last year and quitting is not causing your dryness NOW. does that make sense?

    GPC: sounds like you have it. yes some cases take 6 months to a year. SOME CASES NEVER, EVER RESOLVE.

    allergies to dust, pollen: yes, this is probably the root of the GPC

    "Damage-a burn or tear that is still healing-due to wearing contacts while my eyes were clearly unhappy?"...no that's not it.

    this is GPC. you might not get over it. If you want to get over it, you need to consider Lotemax. not FML, not "waiting and not wearing contacts until it goes away", etc.

    also, maybe try Dailies Total 1 next time you feel good enough to wear contacts!

    good luck. hearty cases of GPC that stick around for years even when you don't wear contacts...well that's not a great sign for getting over it, you know?

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  78. Has anyone noticed or commented that the strength of DT1 appears to be a stronger Rx than AcuVue Moist? Same Rx but vision for distance is much clearer yet vision for reading is much more blurry.

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  79. that sounds like a prescription problem, not a material problem.

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  80. Is there a chance that if someone with GPC goes a year without wearing contacts, but using no drops/medication, would have their GPC symptoms go away? Are drops only essential for patients trying to get back into contacts soon?

    ReplyDelete
  81. "Is there a chance?" Yes, there's a chance.

    Just to clarify...GPC is not dangerous. Drops are almost never "essential". But yes almost everyone posting here is doing so bc they're trying to get back into contacts.

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  82. I've been a contact wearer since I was a teenager (27 now) and never had problems. Currently I'm diagnosed with GPC. I have a strange beginning to my eye troubles that I wondered what you thought of:

    For the last three years, I've travelled to Europe each may/june for about 2 weeks (different countries each time). EVERY TIME I got an eye infection. I hadn't had one since I was a young kid, and never even had allergies. Over there, the pharmacies can give you antibiotics without a prescription. They looked at my eye, saw that it was red and gave it to me. I don't know if it was caused by some new allergies or if I touched my eyes.. but 3 years in a row.

    Anyway, I guess I am wondering if you think those experiences could have instigated GPC? After these experiences I thought I just had developed allergies, so it took me a while to go to the doctor when my eyes had been red/sensitive at home. I have been wearing glasses for almost 3 weeks now after taking FML for 10 days and then Zaditor, but seeing very slow improvement (hard to tell honestly, I think I've lost perspective of what amount of red is normal in an eye...)

    ReplyDelete
  83. If you are diagnosed with GPC, should symptoms go away when you are not wearing contacts? I have been in glasses for 3 months, and did short stints on FML, then Tobradex, and now starting Cromolyn. I just don't understand how my eyes could be irritated if I'm not wearing contacts? I see your comments above about GPC sticking around, but is that only for people trying to continue to wear contacts? What is making my eye red when there is no contact in it?? Thank you!!

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  84. At this point I'm sure you're SO over answering these GPC questions, but since you're the ONLY (amazingly) helpful resource on this subject I'd love to get your opinion on an issue of mine. About 10/11 months ago I started getting all of these GPC symptoms after wearing contacts for over 15 years. I had gotten my yearly eye exam a few months prior, and everyone said "oh you have allergies," so I just accepted that. I was finally able to get a referral to an ophthalmologist and saw her yesterday, and upon flipping my eyelids up she gasped, "oh my god," and ran to the computer to show me a picture of severe level GPC. She told me that I'd need to be on steroids to treat it, probably for many months, monitored frequently for all the risks of cataracts, raised IOP, etc., and I'd probably never be able to wear contacts again. So, definitely my fault for not seeing someone sooner, but after reading about GPC, and especially after reading your blog, I was pretty upset when I received the prescription for Prednisolone Acetate 1% instead of Lotemax. I called her and asked her why Lotemax wasn't prescribed, especially since she had insisted I'd need to be on it for months, and she assured me that my case was so severe (med school student case, she said), that she didn't think Lotemax would really do anything except waste time. I asked her about switching to Lotemax once things started to improve, but she was pretty insistent on sticking with the prednisolone, and wasn't even sure the 4x's a day would work and would need to be upped. SO, since getting another referral for a second opinion will be another ordeal, I wanted to know if you think it's worth taking such an intense steroid that has the potential to cause actual damage to clear up a condition that doesn't cause any damage? Before I saw the Ophthalmologist, my PCP gave me antibiotic drops in case it was bacterial conjunctivitis, and advised no contact use while I was on them. After only 4 or 5 days w/ no contacts, my GPC symptoms improved a TON. Even before then I was able still able to wear fresh contacts comfortably for 1-2 days (I'd always throw them out and start w/ new ones), so I don't see why after a good long while without contact use I wouldn't be able to switch to dailies. I guess the gasp-inducing papillae are still out of control, but my eyesight is already horrible (+7 in contacts and +6.5/7 in glasses) and I'm pretty terrified of developing cataracts, glaucoma, etc. If these potential risks are really rare for ppl in their 20's with otherwise healthy eyes and lotemax will have the same risks if I'm on it for longer than I would be with the pred, than I'll try and stick with it, but something about these drops just don't sit right with me. most of the links I get through web searches are for dogs and cats....

    ReplyDelete
  85. pred is not "stronger" than lotemax. they're different. pred works better on the INSIDE of your eye. lotemax works better on surface problems. while it didn't hurt you any to ise pred...pred has more problems and risks with LONG term use (catracts, glaucoma) than lotemax does. lotemax is very, very safe long term. and I disagree that it would have been "a waste of time". but hey - professionals disgree. no harm being on pred short term. I wouldn't do it more than a few months tho. lotemax, however, you can safely be on for years. I think you can switch to dailies later as well. in fact, you probably should. good luck!

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  86. My story is like many others. Thought I was having prolonged spring allergies. I saw my first eye doc and he actually diagnosed gpc but only gave me patanol. It didn't do much so when I saw another doc in the practice after about 5 weeks of it not clearing up I asked about Lotemax. He seemed hesitant to prescribe but he did but as only 1 drop a day. 4-5 more weeks went by so I decided to try a 3rd eye doc. She told me the lotemax 1xday was doing nothing and bumped me up to 4x day for two weeks. It definitely helped but upon return she also said based on my other tests (tear break up,etc) my eyes were also dry. So she recommended lotaxmax for 2 more weeks along with restasis and to transition to restasis to help with dry eyes and discontinue lotemax. What is it about gpc/ that makes eye docs think it's dry eyes? Can you have both conditions? Lotemax def reduced the giant papillae that all 3 docs noticed but still am having dry/gritty eyes first thing in am but seems to lessen throughout the day but still do have occasional foreign body/burning sensation, redness. Your thoughts? I'm 32 years old. Condition has been going on 3-4 months.

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  87. I know this is an old post but I need advice. I'm 24 and have worn contacts since high school. Several months ago I suddenly had a foreign body sensation in my eye. I tried a new pair and then took a few weeks off of contacts but neither helped. My eyes were red and irritated and after a few hours in contacts I get white sticky discharge in one eye. My eye doctor put me on an antibiotic/steroid drop and told me to take a week of contacts. Then he put me on Beprieve the following week and I was able to wear contacts for a few days successfully. I ended up buying Alaway because of the cost but then my eyes went back to the way they were. Since then I've tried two other allergy drops without results. I've worn contacts maybe 8 hours in the past two months because of the discomfort. I asked my eye doctor about gpc and he said he was sure that wasn't it because the bumps on my eyelids were too small and I don't have any itching. He gave me a trial of DT1 lenses and they felt slightly uncomfortable after 4hours. I was afraid so I took them out at that point and I had a little redness but no discharge. Do you agree that it's unlikely to be gpc? What should I do from here?

    ReplyDelete
  88. Likely to be GPC, even if your doc says he thinks the bumps are small. Need dailies and lotemax IMO. You got dt1...now get an Rx for lotemax

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  89. Excellent article Dr.Prince! I have had issues with my right eye in particular for several months now. I tried every OTC eye drop and nothing worked. I went to an Ophthalmologist and he said I have GPC, Rx Tobramycin & Dexamethasone suspension. He also gave me Restasis because I asked for it. However, I don't wear contact lenses. In fact, I've had 20/20 vision up until this issue. What could be causing GPC? He stated that it was unusual that I had it as I don't wear contacts but didn't really give me an answer. I'm taking the MCAT next Friday and I can't imagine taking it with my eyes feeling this way. Thanks in advance for your help!

    Oh and he said the bumps are massive.

    ReplyDelete
  90. "What could be causing GPC? He stated that it was unusual that I had it as I don't wear contacts but didn't really give me an answer."

    it's allergies. seasonal allergies. dust, pollen, mold, cat hair...whatever you're allergic to.

    ReplyDelete
    Replies
    1. Thank you Doc! Seriously you have no idea how many people you are helping out here! As a future doc (hopefully), It is really inspiring to see this blog!

      I have one more question, what is the best otc eye drops for in door allergies? I'm currently using Zatador but they aren't all that effective.

      Thank you!!!!

      Delete
    2. zaditor is about the best you can do OTC

      Delete
  91. Hello,
    Thank you so much for this informative blog! If you're not sick of GPC questions yet, I have some more for you...

    My contacts have always been comfortable...even recently. About a week ago, I woke up and my right eye was "gunked" shut. I figured it was pink eye. I tossed my contacts, wore glasses, saw my PCP to get an Rx for antibiotic drops. It got a bit better after a day or so, but my eye is still a bit crusty in the mornings (though, I can open it easily). I figured it might be viral pink eye, but then I started googling and read about GPC. Using a Q-tip, I looked under my eyelid, and I see some small bumps. (My left eyelid is smooth though...). I also noticed that while my right eye is mostly clear now, it is still red up on top...the part that is usually in contact with my eyelid.

    I realize I may be putting the horse before the cart by asking these questions before getting an official diagnosis, but here goes...

    1. Is it possible to have GPC, especially early stages, without lens discomfort?
    2. Does GPC sometimes only effect one eye?
    3. I'm currently wearing glasses, and I will continue to do so until I see my optometrist (I have an apt scheduled in a few weeks)...I don't want to make anything worse if I do, in fact, have GPC. Since I haven't had lens discomfort in the past, would you still recommend dailies for the best long term outcome? Will GPC be easier to manage if it never gets out of control in the first place?
    Thanks!



    I have an appointment with my optometrist scheduled in a few weeks.

    ReplyDelete
    Replies
    1. 1) yes possible
      2) yes but usually it's both
      3) IF gpc, then yes dailies are best IMO.

      Delete
    2. I was thinking about this post the other day and wanted to give an update (you give so much great advice, but you don't always get to know how things turn out! :)

      Back in January, my optometrist was fairly certain I just had viral conjunctivitis. He didn't notice any evidence of GPC (phew!), but he did recommend switching to dailies "at some point." (He explained that he recommends dailies for nearly everyone these days.). I chose to stick with Acuvue 2s for this year, then, we'll rework our FLEX spending account to cover dailies next year.

      Thanks for your advice and sharing your knowledge. I felt like I knew what questions to ask to get the most out of my appointment.

      Delete
  92. Hey Doctor! Not sure if my last comment sent but I need your advice ! Best with me on the long post but in desperate here :( In June 2015 I was diagnosed with GPC after trying a new brand of contacts and using a cheap lens solution that caused my eyes to burn. The burning continued and the doctor gave me lotemax to use however this made my eyes worse and I couldn't even open them because I guess I was allergic to something in it. I then went to a different Doctor after my insurance changed who put me on Pataday and rated my GPC a 3/5. Well the Pataday irritated my eyes as well of course as it contained BAK. So I went to using lotemax ointment for 3 weeks in October but I hated it. The ointment stuck to eye once it dried up and my eyes felt worse but however it did bring my GPC from a 3 to a 1 in my left eye and 2 in my right. So now I'm stuck. My doctor tried telling me I was having chronic dry eye and that my GPC was pretty much gone yet he just told me it was still there and was too afraid to put me on drop after because my allergy to BAK. So I stopped going to him and went to a corneal specialist who gave me dry eye tests and my eyes showed no dry spots and I was producing the normal range of tears and my tear film looked good. She says the bumps under my eyes are common and a little more prominent and that it's hard for her to really tell what's causing my constant burning and redness and inflammation in my eyes. So she thinks it's some form of dry eye. Yet I have the same symptoms I've had since my eyes were horrible in June and when I flip my eyelids they look sand papery under there. So here are some questions I have :

    1) does this sound like dry eye or is GPC most likely the root of my problems ? I can't see having a dry eye at 21 especially if I have no dry spots on my eyes and my test film looks great
    2) whenever I rub my eyes the burning gets worse and painful, is this because of the GPC?
    3) because it doesn't itch just burn does this mean it's not allergy ? Multiple doctors tell me this. Yet when they look under my eyelids GPC is there but tell me those bumps are "normal" and most CL wearers have them... They sure don't feel normal
    4) can your bumps be small but still really irritate your eyes ? Mine went down a lot from a few weeks on lotemax but the pain and irritation is still there. I haven't used any eye meds since November.

    ReplyDelete
    Replies
    1. 1) difficult to ascertain
      2) also difficult to ascertain
      3) no IMO could still be allergy. medicine doesn't fit in a box (what does?)
      4) yes small bumps can be a big problem

      good luck! difficult to answer a lot of these questions. this is mostly guesswork

      Delete
  93. Hi Doc, I'm sure you have to be sick of all the GPC questions, but I'm gonna try and get your opinion anyways! :-) I am a long-term contact wearer (20 years) in my mid-30's. I've had bouts with GPC in the past that have always responded well to a week or two off contacts and usually Patanol. But about 7 years ago, my doctor switched me to daily disposables (Clearsight 1 Day) which was a miracle for me, and I no longer had any problems with GPC's impacting my contact use. In October 2015, my doctor said it seemed like I might not be getting enough oxygen to my eye, so she switched me over to the MyDay daily lenses by Coopervision. I noticed my eyes to be more irritated the first few weeks (itchier, dryer) but seemed to get used to it overtime. However, this past February 2016, I started to have the common symptoms of GPC just in my left eye and went to the doctor who made the official diagnosis. She had me use Zylet 4x's a day on the affected eye and no contact wear for about two weeks. I returned to the MyDay contacts and again experienced that initial itchiness/dryness discomfort. I did ask the doctor if it was possible I was having a reaction to the contact change, as I had no issues for the past several years when on the Clearsight 1 days, but she was skeptical, saying I would likely be having the GPC in both eyes. One week later, my contacts started catching again, so I discontinued contacts and went back to the doctor who told me to return to the treatment using Zylet for another week and then start using Pataday daily as well. I then returned to my contacts but then, not sure if this is related, ended up getting episcerlitis in my OTHER eye, which was having no problems! So I ended up having going contactless for another week while putting Pataday in my left eye and some type of NSAID drop in my right eye. After that cleared up, I ended up returning to my contacts, thinking that the extra time off would have just benefited the GPC. After about another week, I noticed discomfort again in the left eye and increased mucus discharge, even with the regular use of the Pataday. I had a follow-up with my doctor today, who was out sick so I saw her colleague. He basically said I needed to be on a stronger steroid for a two week period to clear up what he described as a GPC flareup limited to the upper right corner of my left eye, and also that he felt the Pataday was drying my eyes out and prescribed me Nedocromil to use daily instead. When I asked about whether he thought my use of the new contacts might be contributing, he didn't really answer me but just gave me some samples of Dailies Aquacomfort and some other brands to try. He didn't have a great bedside manner and didn't seem to like all my questions, so I dropped it. I've read some of your posts praising the daily silicone hydrogels, but I guess I'm wondering if you think it's possible the switch to that is causing me to have some of these increased inflamation problems (i.e., the GPC flare up in one eye, the Episcleritis in the other)? I should also say I feel like I can remember at an early age (way before contacts) that I've always had pretty itchy, easily irritated eyes. I appreciate any thoughts you have and thanks for reading what I only realize now is a very long post!

    ReplyDelete
    Replies
    1. yes I think it's probably the silicone in your case. try and go back to MyDay which is plastic

      Delete
  94. Hi, Could you help me?
    I Had discomfort with my monthly CL so I switch to MyDay dailies Coopervision- same discomfort, I found relief in Dailies Total 1 it was perfect i could wear them for 16hours, but unfortunately over 1 month I fell asleep with them twice and the same problem occurred.
    I dropped CL for 3 months. After that period i tried same dailies total one - no relief, same symptoms.
    I went to doctor, he diagnosed GPC. I made 5 months break again. I was prescribed Maxidrol for 2weaks. Then I used Patanol for one months. Over that 5 months I tried CL( dailies total 1) - and again discomfort over 4hours:(((
    What would you recommend? Is there any chance wearing CL even for short periods for sport?

    ReplyDelete
  95. it's not the "falling asleep once or twice", so don't worry about that. you just have a hearty immune response. 2 weeks is probably not near long enough to try and help GPC. heck mast cells turn over every like 21 days so most people agree the MINIMUM treatment needs to be 3 weeks. that's why we all preach lotemax instead of maxidex: b/c lotemax is safer for long term usage. of course the patients just scream "COST!", so we're usually stuck. so really you have to gauge how motivated (money and time) you are to wear contacts. if you were my patient I'd put you on something like TWO MONTHS of lotemax (not "2 weeks" and not maxidex) and switch you to acuvue 1 day moist or acuvue oasys one day. GPC is not dangerous. it's only annoying. so yes, you can wear contacts for short periods for sport. no problem.

    ReplyDelete
  96. fist 2 months of lotemax and AFTER that period dailies? or should I do it simultaneously?
    should I do regular checks at my eye doc during lotemax therapy?

    You wrote :" heck mast cells turn over every like 21 days so most people agree the MINIMUM treatment needs to be 3 weeks."
    but after that 2 weeks of maxidex I did 5 months break from CL, so If mast cell live 21 days It shouldn't be ok???

    Now for my its even not easy to wear them for short periods b/c one, two day after wearing CL I have watery eye, very annoying

    ReplyDelete
    Replies
    1. "fist 2 months of lotemax and AFTER that period dailies? or should I do it simultaneously?" a case could be made for either. the most conservative route is 2 months of no lens wear

      "should I do regular checks at my eye doc during lotemax therapy?" meh. probably not necessary. again GPC is not dangerous, only annoying. and lotemax is fairly safe.

      You wrote :" heck mast cells turn over every like 21 days so most people agree the MINIMUM treatment needs to be 3 weeks."
      but after that 2 weeks of maxidex I did 5 months break from CL, so If mast cell live 21 days It shouldn't be ok???" ah but you weren't suppressing the mast cells anymore after the 2 weeks of maxidex. so...no.

      "Now for my its even not easy to wear them for short periods b/c one, two day after wearing CL I have watery eye, very annoying" haha yes you're just telling me that GPC sucks, which I already knew. sorry! it is POSSIBLE that you may never comfortably wear contacts again.

      Delete
  97. my doc says that I have only few papillae in my eyes so he isn't sure if the symptoms are from GPC. Since last time I used CL (about 3 weeks ago) I have from time to time watery eyes. It never happened before.
    Do you think its from GPC? or maybe dry eye from contacts?

    ReplyDelete
  98. Blepharitis is not an incurable disease; rather than looking for an over the counter anti-infection, treatment or eye drops, you can find a Blepharitis Natural Treatment for apply at home.

    ReplyDelete
  99. Hello Dr. Prince,

    In desperate search for solutions to what seems like an interminable problem with my GPC, I fortuitously ran into your blog where you seem to give numerous people with this condition some hope and insight. I write to you with the same caliber of supplication.

    To summarize, I've been dealing with GPC since May but wasn't officially diagnosed with the condition until mid-June. I started noticing problems with my contact lenses (Extreme H2O monthlies) at the beginning of May since they would move around my eye every time I blinked and I started having fuzzy vision. Towards the end of May my lenses kept bothering me, especially my right lens (Toric for stigmatism) and I went through a new lens every day since I thought that would solve the issue. When I went in to my regular check-up that last week of May with my ophthalmologist, she noticed the GPC bumps on the inside of my upper eyelid, more prominently on my right eye. She referred me to the contact lens specialist and she told me that I should take a small break from contacts and then try a new brand of contacts. I wore my conventional glasses for about three weeks and then I tried on the new trial lenses that they had ordered. As soon as I put them on, my eyes instantly reacted aggressively with inflammation, itchiness, and redness, not even 5 minutes of having them in. At that point, I went back to the optometrist and they prescribed an antibiotic drop to help with the inflammation. The reaction calmed down after a few days, but as soon as I continued contact lens wear, the discomfort re-appeared. I went back to the optometrist and expressed my symptoms: I feel my lens in my eye at all times, the wearing of my contacts is NOT imperceptible, I feel the sensation much more prominently in my right eye, sometimes it borderlines itchiness, but for the most part, it's an annoying, present sensation in my eye. The OD told me discontinue lens wear for like a month and then try them on again. Even after taking a break for a month, once I put my lenses back on, they bothered me again. I was given a steroid drop and it helped some, but not entirely. At this point I had to go back to school and I went to see an OD here in Nashville. She set me on a regiment of putting on Alrex 4 times a day for a week with no contact lens wear and then trying them on. Again, helped some (maybe gave me 2 hours of comfortable wearing time, and then it started bothering me again), but not entirely. Then we tried extending the period of time for two weeks, Alrex during the day and then Bepreve twice a day. Same results - 2,3 hours of semi-comfortbale wear, and then regaining the bothersome, abrasive sensation on my right eye. Then, I tried another week of Alrex & Bepreve and tried on CooperVision Silicone Hydrogel Dailies - a little better comfort but fuzzy eyesight.. so now my eyesight started to become compromised!! I tried two weeks of Alrex and Bepreve and then tried another brand of Dailies, and had the same results - 2 hours of comfortable wear, then bothersome, irritated, foreign-body-on-my-eye sensation, and fuzzier eyesight as the day progressed. The last trial lenses I tried were the CooperVision Silicone Hydrogel MyDay Dailies, which have been the most comfortable out of all the trials but only gave me a few hours of wear before I had to pull out the re-wetting drops to bear the lenses. Right now, I'm taking yet another break and trying to more aggressively attack the GPC with a more concentrated steroid - Lotemax. After about a week of Lotemax 4x a day and Bepreve twice daily, I'm going to re-try the MyDays, which the OD claims are the most comfortable contacts in the market at the moment that include the toric lens, and see how they feel.

    ReplyDelete
  100. (Continued...)

    All that being said, please, I beg you, what do you think I should do? I've tried so many treatment options and NOTHING has worked. I'm at the end of my rope with this infuriating and exasperating condition. I'm a college student who constantly performs, is always on the go, and likes to swim - glasses are just NOT IDEAL. They are a nuisance.

    Am I missing something with my treatment? Is Lotemax the best steroid to treat GPC? Should I try a stronger one? How long should I instill the drops and take a break from contacts before re-trying them? What's the best brand of contacts I should be wearing? Are the MyDay daylies recommended? How would you change my regiment?

    Thanks so much for your time!

    ReplyDelete
  101. I don't love MyDay lenses myself, but that's just personal preference. IMO in cases of difficult GPC the patient probably needs Lotemax (yes, it's the best IMO) and *plastic* dailies like Acuvue 1 Day Moist or Alcon Dailies Aqua Comfort Plus (not silicone dailies like MyDay). If you can't get comfortable using Lotemax and plastic dailies, you probably cannot get comfortable with anything. You should consider LASIK if glasses are not to your liking

    ReplyDelete
    Replies
    1. Dr. Prince,

      Thanks so much for your prompt response. Of the two brands (Acuvue 1 Day Moist or Alcon Dailies Aqua Comfort Plus) which in your opinion carries the more comfortable toric lens for stigmatism? I ask because it's primarily my right eye (where I have to wear a toric lens) that bothers me the most.

      I just started on the Lotamax (loteprednol etabonate ophthalmic gel 0.5%), instilling 4 drops a day and Bepreve morning and night. How long should I be on this regiment while wearing my conventional glasses before I try the plastic dailies again? How long would you consider to be the standard, ideal amount of time to treat the GPC bumps enough to re-try contacts?

      Thanks again for all your help!!!

      Delete
    2. Also, do you think it's just that I'm having an allergic reaction to the SILICONE in the contact lenses? Seeing as that has been a continuous component to all the contacts I've tried?

      Delete
    3. "Of the two brands (Acuvue 1 Day Moist or Alcon Dailies Aqua Comfort Plus) which in your opinion carries the more comfortable toric lens for stigmatism?"

      neither. torics are toe worst with GPC

      "I ask because it's primarily my right eye (where I have to wear a toric lens) that bothers me the most. "

      yep that adds up. no perfect answer. again, torics are the worst. I'd get out of a toric if there was ANY POSSIBILITY of being CLOSE to decent vision w/o one.

      "How long should I be on this regiment while wearing my conventional glasses before I try the plastic dailies again?"

      well...I don;t know bc I don't know the severity of your case.

      "How long would you consider to be the standard, ideal amount of time to treat the GPC bumps enough to re-try contacts?"

      AT LEAST a month. preferably longer.

      "Also, do you think it's just that I'm having an allergic reaction to the SILICONE in the contact lenses?"

      no. that's what everybody jumps to, but that's not a thing. silicone is known to cause more GPC than plastic does, but it's not bc you're "allergic to silicone".

      Delete
  102. Dr. Prince,

    I have been dealing with GPC for the last few months now and nothing has worked long-term. The most comfortable I've been has been for only a couple hours of somewhat feeling my right eye toric lens (MyDay) after a whole week of applying Alrex 4x/day and Bepreve morning and night. My OD now has me on a stronger steroid, Lotemax gel, and wants me to try the Alcon Dailies Aqua Comfort Plus (Sphere on left, toric on right for my stigmatism). My question to you is.. How long should I take a break from contacts while applying the Lotemax and Bepreve before I try this new trial? How much time would you consider to be adequate to clear up the GPC bumps with Lotemax/Bepreve to the extent that I'll be able to gauge an authentic feeling of the comfort level that these new Dailies will give me?

    ReplyDelete
    Replies
    1. there's no perfect answer here bc I don't know the severity of your GPC. could be days, could be weeks, could be never. too many factors to give even a guess. sorry.

      Delete

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