Protocol for GPC treatment?

[SABrown72]

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!

[JohnHaganMD]

You are welcome. Best of luck  JCH MD

[SABrown72]

Ok, thanks. I don't think that I really meet any of those conditions - I don't have a headache, double vision, or anything like that, and there aren't any signs that anything is abnormal with the lid.  My pupils are the same size and not dilated.  

The primary symptom is that the lid feels heavy and aches - when I close my eyes it feels slightly better.  It felt fine this morning, and has gotten worse throughout the day.  

THANKS.

[JohnHaganMD]

If an eye is painful such as a scratched cornea the eye pain can cause what is called "guarding ptosis"  the pain however is coming from the eye. In cases where the eyelid is swollen and has ptosis due to problems in the lid itself such as a style or chalazion the stye might cause pain. In most cases however ptosis is not a painful condition.  Severe headache, ptosis, dilated pupil and double vision can be a sign of aneurysm causing a 3rd nerve palsy.

[SABrown72]

Thanks, I will.  To be clear, I haven't worn CTL in a week...

Is ptosis ever painful or achey?

[JohnHaganMD]

Wearing a CTL just confuses these issues as it adds one more variable. GPC is generally not painful. I think you would need to report this to your ophthalmologist.

[SABrown72]

THANK YOU.  Yes, it's been there since birth, but I think that this is worse than my baseline - maybe 1 mm worse?  

Also, the upper eyelid aches and feels heavy - more on the outer edge of my eye - is that consistent with GPC and the ptosis, or is it something I should follow up on?  it's gotten more painful throughout the day- not too bad, just achey.  THANKS!

[JohnHaganMD]

You said for the first time that you have had ptosis since birth.  That makes it much less likely that its due to anything serious. Sudden onset of ptosis needs an extensive work up to be sure its not Horner's syndrome, tumor, stroke, myasthenia gravis, 3rd nerve palsy, etc.

[SABrown72]

THANK YOU.  Not to be obtuse, but in what way is the history important?  In terms of ruling out other disorders/diseases?

[JohnHaganMD]

The dye in the eye does not check for Horner's.  The additional history you give is incredibly important if the present ptosis is in the eye noted previously to have ptosis.   Ptosis can worsen with time as tissues stretch as we age and the GPC may aggravate also.   Opticrom (cromolyn sodium) is available in a generic form but I believe it is still a prescription medication most countries. your ophthalmologist should be able to prescribe it without another visit if you can him/her. It is not approved for use on a contact lens (in the eye)

[SABrown72]

Oh, and the ophthalmologist did put a dye in both eyes, so I *think* that she checked for Horner's syndrome.

[SABrown72]

Thank you VERY much for the comprehensive reply.  I have no interest in wearing contacts for a while, so I'm fine with not wearing them.  I do know that I have a small degree of ptosis that's congenital; it was measured about 20 years ago and the ophthalmologist was going to check my records to see how much it's changed (I've been with the same practice since I was 10, and I'm 43 now).  incidentally, my mother, grandmother, and greatgrandfather all had ptosis, and my mother and grandmother had it surgically corrected.  

Is Opticrom over the counter or prescription only?  Thanks!

THANK YOU!

[JohnHaganMD]

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

[SABrown72]

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!  

[JohnHaganMD]

Great. Let us know what that shows JCH MD

[SABrown72]

Thank you!  I'm getting a third opinion tomorrow.  I'll follow up.

[JohnHaganMD]

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.

[SoftwareDeveloper]

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.

[JohnHaganMD]

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.

[SABrown72]

THANK you - this is very helpful.  In a mild stage, do you need medication or will the GPC resolve on its own without medication?

[SABrown72]

Thank you!  Will it typically resolve by just stopping wearing CTL?  And how long does it typically take to resolve?  THANK YOU!

[JohnHaganMD]

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