GPC GPC GPC GPC

It's rampant right now, mostly b/c here in East Texas we have had an unusual amount of winter/spring rain and the pollen is high high high. The allergist tells me its a 25 year high for pollen count. So even some people who have "never had allergies before" are having them this year. I have blogged on this 3 other times (here, here and here), and they are 3 of the most commented-on posts on my entire blog. It's a hot topic because it's a common problem that's very often misdiagnosed. And even when it's diagnosed correctly it's often treated improperly. Add to it that there is very little information on the internet about it and that the symptoms sound (to a regular doctor) like those of "pink eye", and you can see how this can snowball quickly. This has all been hashed out in gory detail on this blog before, but just to hit the high points again: 1) if you're a contact lens wearer with chronic red eyes, it's almost assuredly not "pink eye" that you're "catching over and over" 2) if your contacts used to fit fine but now they "move around a lot" or even "pop out", that screams GPC, no matter what your PCP says 3) don't go to a PCP for eye problems anyway 4) if you're young (under 40) and your contacts bother you it is probably not "dry eye" 5) if you have confirmed GPC, stop messing around with Rx's for Pataday. The real, long term fix is switching to DAILIES. 6) freshly-diagnosed cases of GPC who are miserable need Lotemax. Not FML or pred or dexamethasone or worse: crolom (6.5 if your doctor suggests crolom, find a new doctor). I actually read on Wikipedia (bad source, I know) that diphenhydramine (Benadryl) is often prescribed for this, and that brings up a point that I have been meaning to blog about. NO ANTIHISTAMINE PILL will do anything for your eye problems/symptoms. Yes, I know it says on the Benadryl and Zyrtec boxes that they treat "itchy, watery eyes". But it is my experience that it doesn't work well at all. Its "too far": swallowed, deposited in your stomach/digestive tract, absorbed into your bloodstream, metabolized by your liver, then travels AAAAAAAALL the way to the VEEEEEERY end of the capillaries on the surface of your eye...then delivers a dose of antihistamine that is potent enough to stop itching and watering? I think that's just a taaaaaad optimistic. How about apply the antihistamine (or better yet Lotemax) right to the site and get immediate results with the full potency directly to the area of the problem? Yeah that's more like it. It is my opinion that if you have itchy, watery, red eyes, NO PILL will work to give you relief. You need eye drops. What else? Please post new GPC questions here. Trying to find your new question amidst the literally hundreds of comments from 2009-2011 is really quite difficult. WHEN ASKING A QUESTION THAT YOU WANT A REPLY TO: always be the last comment. Don't "reply" to an OLD comment that's in the middle of a bunch of other old comments...that makes your question very hard to find and answer.

Comments

  1. Hi doc, thanks a lot for the opportunity to ask about GPC.

    I stopped wearing contacts 2 years ago (my last brand was Air Optix for Astigmatism). At that time I felt that the contacts were less comfortable than when I started wearing them. They were quite uncomfortable for a few hours in the morning, then it got better, it was quite OK during the day. But in the evening after some reading they became dry, and it even felt like my eyes or the lenses were kind of heated or hot. However, the contacts fitted OK - they didn't move around, and never popped out.

    After 2 years without contacts, I don't have much problems with my eyes, except that my lower lids are more sensitive to touch than before (but this got slowly better during those 2 years) and except sensitivity to sunlight. I also have pollen allergy which sometimes causes that I strongly feel the presence of the inner surface of my lower eyelid (mostly left). It is a strange uncomfortable but bearable feeling. It is usually back to normal after a day or two.

    Would you consider this as a possible mild GPC? Thanks a lot.

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    1. Doesn't have the hallmark complaints like constant redness, lenses moving around, etc. Hard to tell from that descrption. There are plenty of reasons contacts can be uncomfortable. Not all uncomfortable contacts are from GPC. Would need to evert lids and look for bumps

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  2. Hi, thanks for this blog! I recently got diagnosed with GPC and the blog has been immensely helpful.

    I used to wear ACUVUE Advance contacts for years, until they stopped making them. My eye doctor didn't like the replacement version of those lenses, so she prescribed AIR OPTIX lenses. I wore those for almost a year, and over the course of that year, they became less and less comfortable. I went to the eye doctor, who diagnosed GPC and said it was probably my contact solution and not the contacts. After using steriod drops with no contacts for two weeks (which helped), switching to Bausch & Lomb sensitive eye saline was no help, and my eyes got increasingly irritated each day I wore the contacts. Now I am trying out Proclear 1 day contacts, and it seems much better. I am wondering if I should stick with these or insist on something with lower surface friction like ACUVUE MOIST or something else. Also, was it really the contact solution or the contacts that I am sensitive to? I do have seasonal allergies, so perhaps I am prone to GPC.

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    1. It is likely NOT the solution that you are/were "sensitive to". Its allergies and silicone. So your eye doctor doesn't like the lens that acuvue advance was replaced with? That's acuvue oasys...far and away the best selling lens in the US. That's like saying your doctor doesn't like Coke, haha

      Stick with dailies. Probably doesn't matter too much which one. The people who have GPC... Most of them do fine in dailies, usually doesn't matter too much which one. FEW of them do fine in any 2 week or monthly silicone lens, doesn't matter which one.

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  3. Hi. I was diagnosed with gpc in march. I used opticrom for 2 and half months and have been out of contacts ever since. I recently went back to my optomotrist who said my eyes had become dry (I believe from the opticrom) and he also prescribed an artificial tear drop. I went back again a couple of weeks later, and he said that there was no improvement. What I found a little puzzling is that he didn't actually look under the lid itself? Is it possible to make an assessment of gpc without looking under the lid? My eyes look and feel completely fine now i'm not in the lenses, no redness, itchiness, watery-ness, nothing. So as far as I know the only real symptom still displaying is the bumps under the lid. Anyway, i've stopped using the opticrom all together, because it's clearly doing nothing other than potentially making my eyes dry. I finally have an ophthalmologist appointment on Monday, is there any advice you can give me to get the most out of my appointment? These appointments are particularly difficult to get here in the UK so i'm concious of making the most of it. I'm praying they are as familiar with this topic as you.

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    1. Not really too much advice. Make sure they look under the lids. Consider dailies. Good luck!

      No it is not really possible to assess someone's GPC w/o looking under the lid. You should know that GPC often becomes chronic...juat bc you have few/no symptoms right now doesn't mean it's gone.

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  4. Hi, i just wrote a comment but i'm not sure if it sent, so sorry if i'm repeating myself. I went to my appointment today and as I expected they opthamologist was pretty useless. She said that my case was moderate at the moment and that she wouldn't give me any steroid drops but to stay out of lenses for another 6 months!!! Pretty disappointed that she wouldn't try me with stronger drops. She's just prescribed more artificial tears.

    At what stage would you introduce daily lenses? Would you usually wait until the bumps under the lid have cleared up entirely?

    I'm going away at the end of the week and i have five pairs of these lenses http://www.specsavers.co.uk/contact-lenses/categories/daily-disposables/dailies-total-1

    Do you think if i used these that that could set me back?

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    1. So let's talk. GPC is not dangerous. It's only annoying and uncomfortable. It will not blind you or disfigure you. There's basically no risk in trying to wear dailies.

      Almost no one totally gets rid of the bumps. With any method. Steroids, artificial tears, dailies, staying out of contacts... None of that usually works to get rid of the bumps forever. When you go back in 6mo you will very likely still have bumps. Even if you stay out of contacts and use artificial tears.

      What we are usually trying to do with dailies and steroids is just make the lens wear tolerable. We are not waiting until the bumps are "gone" or "healed". That's probably fantasy. I usually Rx steroids and dailies and try to get the patient relatively comfortable. That's it. It's not magic.

      Lotemax is not a "stronger" steroid. It's just different. Safer. Less likely to cause cataract or glaucoma. Way safer than seemingly everyone's favorites - dexamathasone and prednisolone - which are pretty much known to cause both cataracts and glaucoma.

      I put my patients in dailies as soon as they want to try them. Waiting 6mo and using artificial tears is not some magic cure that's likely to work. If you can wear dailies right now it is absolutely safe to do so... Because again this is not a dangerous condition. If you can't wear dailies, well then you probably could use steroids to get you to that point. Not to "cure" your GPC. Just to make it where the bumps are small enough that you can comfortably wear dailies.

      This is the big problem with GPC. I feel like not enough practitioners know what to do with it. Many of them misdiagnose it (as "dry eye", etc) and then even when they get the diagnosis right they're not aggressive enough with the treatment. Just try the dailies. What's the worst thing that can happen? I'll tell you: the worst thing that can happen is that you (still) can't comfortably wear them. Well so what? What have you lost by trying? I don't understand what waiting 6 mo is going to do. Nothing. Just my opinion. No it is not going to "set you back".

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  5. Thank you. Honestly i get so much more sense out of you than i do my own doctors. I'll give the lenses a go and see how i get on.

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    1. As an aside: most ophthalmologists are surgeons. They have little experience with contacts or contact problems. The AMA wants you to believe that since ophthalmologists go to medical school that they somehow "know more" about EVERY eye problem than any optometrist ever could. The result is "stay out of contacts for 6mo and use artificial tears". Sorry for the rant haha

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  6. Rant away. It's nice to find someone who knows what they're talking about and understands how frustrating this can be for people, especially when they're getting misinformed treatment.

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  7. Hi there -

    Great posts on GPC. I have a question:

    I have seasonal allergies to grass and ragweed, and where I live the allergy season this year has been bad (as in most of North America). I've been wearing Total Daily 1s for the past year, not on a daily basis, but rather 1-3 times per week. I don't like to wear contacts every day, especially at work - I prefer the weekends and when I exercise. I still feel GPC symptoms though, even after being on medications in the past year (Lotemax, Patanol in particular).

    Total Daily 1s - are these silicone? I'd like to try a different brand of contacts, preferably non-silcone ones. Do you have any suggestions?

    Thanks

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  8. Hi, thank you for spreading information about gpc. I commented on another post a while ago about my situation and asked for advice. Basically I had been having severe discomfort in my silicone monthly disposables the point that I stopped wearing them. I had red eyes, bumps under my lids, light sensitivity, discharge, contacts moved around a lot and felt very dry. My eye doctor tried me on several allergy drops to no effect. Dailies helped but were still uncomfortable after a few hours. I asked about gpc directly and he seemed offended and said he was sure it wasn't that because my papules didn't qualify as giant and conjunctivitis involves itching. He then recommended some rewetting drops and warm compresses and said that I had dry eye but that it didn't seem particularly bothersome. I was irritated at that comment especially because I hate wearing glasses but have been dealing with them almost full time for nearly a year now. I don't think I will be returning there. I'm thinking about trying a new eye doctor. What should I say to point them in the right direction without being rude? I don't want to say, "hey, I've done some extensive googling and I know exactly what my problem is. All I need from you is a lotemax prescription and some more dailies."

    Thank you for your time!

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    1. haha it's tough. dryness is the #1 complaint of all CL wearers so a lot of doctors fall back on that. I wouldn't do hot compresses.

      you could say something like what you posted, except in a more PC way. the funny part is - I have had people say that to me and I am not offended. in a couple of cases they were right and I did what they asked. in a couple more I disagreed and nicely explained why. but telling the doc what you think is wrong and what you think should be done "shouldn't" be offensive. It may depend on when you vcatch them. In this case I might try to avoid being the 4:45pm appt on a Friday haha

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  9. Dr. Prince, thanks for addressing the misdiagnosis. My last incident of GPC was over 30 years ago, but I recognized it immediately and went off to my ophthal for some Opticrom. Well, not only did I not get my Cromolyn (no suprise to you), I also did not get my eyelid everted, because the doc immediately diagnosed dry eye. Yeah, that's probably happening concurrently; I live in a desert. I do have a new doc who was willing to flip my lid (no one should have to beg for that) and some Lotemax!
    So...can I ask about Cromolyn? Opticrom is over the counter in the UK. Is there any harm in my trying it? This would be after Lotemax, after the rest period (I can't tolerate my current lenses [silicone hydrogel, 2week disposables] for more than 15 minutes) and daily disposables. It really helped me 30 years ago, and maybe I'm clinging to false hope, but I'm highly motivated to get back into contact lenses. The OTC Opticrom is 2%, not 4%.
    Thanks for reading.

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    1. no harm in trying it. not too optimistic it will help much but I've been wrong before!

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  10. Hi!

    I was diagnosed with GPC this time last year, wearing monthly extended wear lenses. I spent 3-4 months out of lenses all together and was given virtally no affective treatment other than time to heal. I then moved onto daily lenses (from following your advice) and have been comfortable with these ever since. Now it is 'that' time of year again that allergies are appearing, i'm getting paranoid that my gpc may resurface. In your opinion, is it a possibility that dailies (worn roughly 6 times a week, 12 hours a day) will reignite this problem for me? I'm currently having no symptoms, but if it's a possibilty, can you advise steps I could take to help prevent a reccurance if this issue?

    Many thanks.

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    1. gpc is really, at it's core, an allergy problem. seasonal allergies, not allergies to contacts. wearing dailies makes the risk of it returning *lower* (much lower than extended wear), but it does not eliminate it. the contacts are only 1 of the 3 big factors. the other 2 are: 1) your individual allergy response and 2) the amount of allergens currently in the air, both of which are highly variable. so - who knows if it will come back? it very well could! one thing you could do to sort of "pre-emptively" act is to start on antihistamine (anti-allergy) eyedrops. there are 1-2 good ones over the counter. try "Alaway" by Bausch & Lomb twice a day...once before you put the dailies in and once after you remove. that'd go a long way and you'd be doing the most you could do w/o another visit to a doc and an Rx medication. good luck!

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  11. 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!

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

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  13. how is it possible I was better on Dailies Total 1(silicone, modulus 0,7) then on Mayday( modulus 0,4) ? don't get it.

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  14. sometimes medicine doesn't fit in a "box"...

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  15. ... also the lenses don't feel like they're moving around in my eye. I'm trying to remember just how my GPC felt last year, and it was mostly contact lense movement, blurred/cloudy vision, and a lot of itchyness

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