Copyright 1996-2001 by Larry Bickford. All Rights Reserved.

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The EyeCare Connection

The EyeCare Reports


PLEASE READ THIS: The information contained herein is not intended as a substitute for medical advice and care from qualified, licensed health care providers. The reader should regularly consult a physician in matters relating to his or her health and particularly with respect to any symptoms that may require diagnosis or medical attention. The information is presented here to educate and inform and to guide you to an understanding of cause, prevention as well as treatment.

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Giant Papillary Conjunctivitis (GPC)

By E. Lawrence Bickford, O.D.

GPC is a not uncommon, although sometimes missed complication of contact lens wear and/or hay fever allergies. GPC is in actuality your body's reaction to allergens in your tears or attached to your contact lenses.

The Symptoms of GPC

The inside of the eyelids and the sclera (the "white of the eye" ) are covered with a very thin tissue called the conjunctiva. In GPC, the membrane swells in what is called a papillary response. There is increased mucus production, irritation, itching, sometimes photophobia (light sensitivity) and decreased tolerance to contact lens wear. Soft lens wearers may find their lenses moving with the blinking of their eyelids, further irritating the eye and causing even more mucus secretions---creating a cycle of increasing severity of symptoms.

The Causes of GPC

The causes of GPC include contact allergy and perhaps immune system reactions. Typically, GPC results from: exposure to chemicals and preservatives in contact lens solutions, the plastic material itself, pollens and other airborne allergens, or can occur secondarily to a bacterial infection. Hay fever is considered to be a primary precipitatory factor, as are chemical preservatives in lens care products and eye drops. Additionally, overwear and mis-use of contact lenses, especially worn, damaged or soiled lenses can cause GPC.

Treatment and Management

First, you must remove the source causing the inflammatory response. Contact lens wear is discontinued, often until the symptoms completely resolve. The previously used lenses, if soft, are discarded, as the contaminants might be attached to the lens material. As it is possible that the type of plastic used to manufacture the contact lens is the irritant, a lens of different material may be advised. Lens care solutions are altered to reduce or eliminate potential chemical irritants. If hay fever is the primary cause of GPC, medication to address that condition systemically is required, as well as medications to treat the ocular surface condition.

Medications can be used to inhibit the papillary reaction while waiting for the conjunctival membrane to de-toxify and repair damage. Pharmacological agents applied as drops include: mast cell stabilizers, such as cromolyn sodium (Cromlon, B&L), lodoxamide (Alomide, Alcon) and histamine blockers such as levocabastine (Livostin, Ciba). Oral antihistamines, such as Benadryl and Chlortrimeton may be used. In acute symptomolgy, for rapid relief of symptoms, anti-inflammatory drops such as ketorolac (Acular, Allergan) or corticosteroid drops can be used to quiet the reaction.

Treatment to resolve GPC can take one to six weeks.

Prevention

1. Do not wear damaged or dirty contact lenses. Replace them as necessary to maintain the highest level of lens hygiene.

2. Always thoroughly clean and disinfect lenses between use. Do not wear irritating lenses. Do not wear them if you think you may be developing an infection. If you sleep in contact lenses, remove them for cleaning and disinfection before discomfort occurs. Consider not leaving your extended wear lenses in overnight. For soft lens wearers, use unpreserved solutions when possible. Always rinse lenses in unpreserved saline before inserting. Of course you should always wash and dry your hands before handling contact lenses and avoid soaps with antiperspirant chemicals, perfumes and other additives.

3. If you have hay fever, consider medication before symptoms become severe.

4. If you have dandruff, especially in your eyebrows, treat the condition and avoid getting the debris in your eye.

5. If you have dry eyes, use unpreserved drops to keep them moist and well lubricated and seek medical attention for on-going treatment.

6. Avoid contact with airborne chemical vapors and sprays. Wear safety glasses or goggles if in situations where such contaminants could get in your eyes.

Hygiene is a critical issue. The sooner the condition is treated, the less damage to the conjunctiva and the faster the recovery. And, of course, the less inconvenience and medical costs.