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Protocol for GPC treatment?
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Protocol for GPC treatment?

Starting 11 days ago, it felt like there was something under my right upper eyelid.  I wear contact lenses, but change them religiously every month, as prescribed, and never sleep in them.  Five days later, I had a routine appointment with my optometrist to correct my glasses/contact lens prescription.  When I described the irritation, she looked under my eyelid, said that I had papillaries, and recommended using a hydrogen peroxide solution for cleaning my contacts.  Two days after that, I had my routine semi-annual appt with my ophthalmologist.  My eye exam was normal, but when I told her about the irritation, she looked under my eyelid, said that I had GPC, and just told me the same thing, to change my contact lens solution.

After reading about GPC, I immediately stopped wearing my contact lenses, and am on day 3 of glasses only.  But I'm still experiencing irritation under my eyelid, the undereye area of that eye is puffy, and I'm worried that there is some ptosis of that eyelid.  Should I get a second opinion, and are eye drops warranted?  Is it typical for the undereye area to be implicated?  Same with ptosis?

THANKS!
10 Comments Post a Comment
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177275_tn?1438375244
Changing your CTL solution is not the solution to GPC. Generally you either have to stop wearing conacts (GPC is a very common reason for people to have LASIK)  or go to one day contact lens (wear one day and dispose), cut back CTL wearing time and use Opticrom eye drops.   If you feel comfortable with your Optom or Eye MD you can return for a more in depth discussion or you can get a 3rd opinion.

JCH MD
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Avatar_m_tn
Thank you!  Will it typically resolve by just stopping wearing CTL?  And how long does it typically take to resolve?  THANK YOU!
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177275_tn?1438375244
You can Google Images GPC and see the various stages. It varies from a pre-clinical stage that has only tiny papillae to huge advanced stage where the back of the lid looks like a cobblestone road. I suspect yours is in the early stages or your OD or Eye MD would have been much more concerned.  In the advanced stages (cobblestone) it can take 6-9 months without any contacts for the tissue to return to normal. If you have GPC it means you are sensitive to the protein that builds up on a CTL even with cleaning. Thus the need to go to daily CTL that are replaced every day. In a mild stage without CTLs the tissue might look and feel normal in 3-6 weeks.
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Avatar_m_tn
THANK you - this is very helpful.  In a mild stage, do you need medication or will the GPC resolve on its own without medication?
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Avatar_m_tn
GPC varies quite a bit in how quickly it resolves, from days to over 14 months and unresolved despite no contacts anymore. If you have allergy issues then that can play a factor and allergy meds can help, as can changing contact lens brands to ones with different materials or perhaps a different fit. I wore contact lenses for decades, and for the first couple I'd sometimes get GPC during allergy seasons and need to stop contact lens use for days or a few weeks and it would  go away.  Then I had better luck with newer material/design contact lenses, or perhaps their fit, and the last decade would only need to avoid contact lenses for a day or so during the worst of allergy season and didn't develop noticeable bumps.

Then a bit over a year ago I had a cataract that shifted my prescription from around -9 to -19 in one eye over a couple of years, and for the last couple of months   had to switch to a different contact lens brand that went up that high, which gave me GPC again, perhaps due to the material or fit. I didn't notice the GPC at first since I think the contact lens was serving as a shield during the day (wearing it all waking hours) and it just felt like a slight irritation when I first took the lens out, as I've had at times during allergy season before, it didn't seem like something to be concerned about. When I stopped wearing the contact lens a week before surgery, without that shielding my eye, I began to feel the irritation whenever I blinked, and the OD confirmed it was GPC (I wanted to make sure it wasn't an infection or something preventing surgery). Fortunately within a few days it  got much better and wasn't   too big a deal,but was still bothersome each day for a few weeks.. and it didn't resolve completely. Even now over 14 months later of not needing contacts I'll notice it for a few minutes occasionally   when my eye is  dry (wetting drops help)  or allergies are acting up despite drops&pills.

My optometrist had just had me using allergy drops, and hadn't suggested there was any other way to try to get rid of it other than giving it time. I hadn't yet researched online or  asked an MD about whether they can remove the remaining bump(s) since they hadn't gone away yet on their own, it is still annoying occasionally.
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177275_tn?1438375244
By switching to daily contacts, reducing time wearing them (or obviously by stopping wearing contacts) GPC may regress without treatment in mild early stages. In advanced stages medication and discontinuing contacts is necessary.

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Avatar_m_tn
Thank you!  I'm getting a third opinion tomorrow.  I'll follow up.
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177275_tn?1438375244
Great. Let us know what that shows JCH MD
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Avatar_m_tn
I had my third opinion today - she said that it's definitely GPC, mild stage, and I have papillaries under both my eyelids.  Since it's mild, she recommended using Zapitor twice daily, indefinitely, and trying contact lenses in a week or so.  

I do have a ptosis of 2 mm; she said that it may get better as the GPC resolves.  Any opinion on the ptosis?  It's bumming me out!  
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177275_tn?1438375244
I think your chance of wearing contacts in the future is guarded. Zaditor is an OTC allergy medication. It is not specific for GPC.   GPC as a cause of ptosis has been reported many times, here's a good reference:  http://www.ncbi.nlm.nih.gov/pubmed/6643895   My experience is that if you continue with 30 day replacement daily wear contacts and only Zaditor you GPC will worsen and your ptosis will not go away or could get worse.  This is how I've managed these cases as a generalization. Stop wearing contacts. The ptosis should clear in 6-8 weeks. If it doesn't you would need to see a neuro-ophthalmologist or oculoplastic surgeon to rule out other causes of ptosis (e.g. Horner's Syndrome)    If the ptosis goes away and your eyes feel better after a couple of months without contacts and your strongly wish to stay with them (as opposed to going to LASIK surgery or glasses) then you could try one day disposable contacts using one/day and cutting back the wearing time to just when you're out in public. Might consider using opticrom (chromalyn sodium) and seeing your optom contact lens fitter every 4 months to flip the lids and see if the GPC is coming back.       JCH MD
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