Diagnosed with blepharitis and GPC; next steps?

I've occasionally posted here on my contact lens experiences. Quick
recap: Wore those now-repudiated one-year extended wear lenses for a
year on a weekly cleaning schedule in 1988-1989, daily wear gas
permeable lenses for another year in 1990-1991, and Acuvue on a five-
or six-day extended wear schedule since late 2000. No complications at
all, other than a slight increase in morning and intraday crusting
when on extended wear; easily manageable and not a bother at all.

In late 2003 I decided to again try out Focus Night & Day 30-day
extended wear schedule. My first set had no problems, but midway
through the second my right eye started gradually, then severely,
crusting up (lashes sticking to bottom eyelid, lens riding up,
etc.). I figured it was something that could be taken care of through
lens cleaning and/or changing lenses; no luck. After dealing with this
for several weeks I went to my optometrist, who diagnosed a bacterial
infection and prescribed first Polymyxin B, then a white cream whose
name I don't recall. No luck; once I put my lenses back in after the
prescribed treatment periods the crusting would recur after a few
days, on some days to the point where the eye would be stuck shut when
waking up.

(Interestingly, during this period I had reason to wear a leftover
fresh Acuvue pair for a week; I had no particular crusting issues
while wearing them at all. But the crusting returned within a day or
two of returning to Night & Day.)

This morning went to an ophthalmologist recommended by the
optometrist. She promptly diagnosed giant papillary
conjuctivitis--likely caused by some kind of allergic reaction to the
Night & Day lens material--and blepharitis. I am to:

* Do a 10-minute hot compress twice a week to manage the blepharitis
(The ophthalmologist says she has a bad case of it herself, and
sometimes has to do it every day for a week). She suggests using tea
bags; having never had tea in my life this will be a new
experience. Interestingly, no mention of a lid scrub using baby
shampoo or anything else; I wonder why?
* Give my eyes a few days' break (I should mention that I had been
wearing glasses for a week but had to put in the Night & Day lenses
yesterday after the frame broke; I had it fixed while at the
ophthalmologist, and of course took the lenses out before the
examination), go back to Acuvue, and report back to her if the
symptoms recur. Based on my experience above I don't expect them to.
* That said, when asked her professional opinion on the wisdom of
wearing Acuvues for extended wear, the doctor mentioned the risk of
"waking up with an ulcer one morning" (she has no problems with
daily wear), no matter how much luck I've had with them in the
past. Nothing to do per se with the GPC or blepharitis; just the
kinds of concerns that have been discussed in this newsgroup many
times.

My questions:
* Given that the problems only occurred with one eye, could they have
been originally caused by a fitting issue? I know that the vision
through the Acuvue was always marginally sharper, due to a more
precise base curve available.
* Might another silicone hydrogel lens, such as Acuvue Advance or
Purevision (assuming the US patent issue ever gets resolved), prove
to work better for my eye?
* I know doctors, whether MD or OD, are supposed to (and rightly so)
be as cautious as possible when counseling patients. I well recall
as a student once assisting a professor of ophthalmology at Columbia
University's medical school on a computer issue who, during the
meeting, confirmed without actually being able to explicitly say so
that yes, disposable lenses can be used for a considerably longer
period than they are prescribed for. Now, even knowing that, I'm the
type of person who would never use a daily disposable lens for more
than a single day. (During the year of wearing gas permeables I fell
asleep overnight wearing them exactly once, which I suspect is a
pretty good record.)

That said, given my good track record with Acuvue as extended wear,
am I truly doomed to an ulcer in five or ten years if I continue to
1) never use each pair of lenses longer than the above-mentioned
five or six days a week, 2) always give my eyes *at least* an
overnight (typically a full day or more) break between lenses, 3)
and faithfully get my eyes checked out on a regular basis (annually
so far, but I can easily make that every six months or fewer)?

Or should I just give up, and switch to daily wear or daily
disposables?

 

Yes, I should have mentioned that; the doctor said there was "some"
GPC in the left lid. I wonder if, had I continued using the Night &
Day lenses, it'd have worsened over time, or would it have stayed in a
"stable" state?

That's depressing to hear. That said, I am willing to experiment, now
that 1) I know what's going on and 2) I know what I have is not vision
threatening.

See, the whole reason why I like using extended wear (whether monthly
or weekly) is that I *really* dislike the whole in-and-out,
clean-each-night routine of daily wear even though, as mentioned
previously, I only missed a single night in a year of doing it as a
teenager; dire threats about massive hypoxia are a healthy incentive
to diligent action.

Daily disposables are a partial solution but, of course, not
completely; that said, they might prove beter for my own preferences,
disregarding cost. I'll price them versus Acuvue 2 + cleaning solution
and think about whether I want to pay the difference.

 

Well, I certainly hope the return to Acuvue (whether regular, 2, or
1-Day) will not hamper the healing of the GPC bumps!

Speaking of which, what *is* the difference between Focus Dailies and
1-Day Acuvue? The former is about half the price of the latter. A
Google Groups search in this newsgroup turned up nothing hugely
relevant, other than that the same price difference existed four years
ago.

 

How about wearing glasses.... That should cure the GPC and maybe make the
blepharitis better....

Thanks,

Mike

 

According to the Chang study (Lancet, 1999), the rate is 1/500 cases of
bacterial keratitis per year from sleeping in lenses. This can be reduced
by a factor of 10 by simply removing the lenses nightly.

DrG

 

major SNIP


Why GPC?

Allergic? Definitely. Most of my patients with GPC seem to have seasonal
flareups.

Mechanical? I definitely think so. For those of us who are old enough to
remember when GPC was a more common phenomenon(it is now rare in my
practice), we can all remember how the incidence seemed to drop when
manufacturers learned that the edge profile of the lens was important to
comfort.

Lens surface/material? I think this is a factor as well. As Dr. Tyner has
mentioned, some materials have greater affinity for proteins, having a
charged surface. We know that silicone hydrogels have an affinity for
lipids, and that they tend also to promote the formation of mucus balls. I
have learned to judge a lens by feel, i.e. how the surface feels in my hand
when I rub the lens between my fingers. Some lenses have a higher
coefficient of friction, and I think that this friction can be a factor as
the eyelid rubs over it thousands of time in a day. It is generally
thought that people with dry eyes tend to have a higher risk of developing
GPC because of the surface deposit/friction issue.

With respect to these factors, how does the Focus N&D stack-up? I have
also worn that lens. One of the perceived problems I have with that lens
is its rather smallish diameter. This can result in an annoying edge
sensation in the flatter base curve. Whereas the 8.6 curve might be fine
in a larger lens, it tends not to be the lens of choice in the Focus N&D.

If the edge is not the problem, then the material must be disagreeing with
you. In this case, the Purevision may indeed be another option. But, I do
agree with Dr. Tyner that a daily disposable may be the best way to manage
GPC, along with topical medication. Daily disposable also have the best
safety profile.

DrG