Diagnosed with blepharitis and GPC; next steps?

Discussion in 'Optometry Archives' started by Yeechang Lee, May 12, 2004.

  1. Yeechang Lee

    Yeechang Lee Guest

    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

    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
    Yeechang Lee, May 12, 2004
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  2. Yeechang Lee

    Yeechang Lee Guest

    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
    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.
    Yeechang Lee, May 13, 2004
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  3. Yeechang Lee

    Yeechang Lee Guest

    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
    Yeechang Lee, May 13, 2004
  4. How about wearing glasses.... That should cure the GPC and maybe make the
    blepharitis better....


    Mike \(Remove X's to reply\), May 13, 2004
  5. Yeechang Lee

    Dr. Leukoma Guest

    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.

    Dr. Leukoma, May 13, 2004
  6. Yeechang Lee

    Dr. Leukoma Guest

    major SNIP

    Why GPC?

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

    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

    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.

    Dr. Leukoma, May 13, 2004
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