GPC and dry eyes

[Emma3587]

Dr Gemoules

I have had approximately 6 successfully treated episodes of GPC (over the last 12 years). I noticed my eyes becoming drier and drier with the more episodes I would have. At present my eyes are VERY Dry. I was last diagnosed with GPC March 2006, and it has not competely subsided. I believe the prescribed topical anti-histimines are in part responsible for my chronic dry eye symptoms at present. I took these for over 8 months, together with a topical steroid drop.

My eyes NEVER feel comfortable. Some days are worse than others. Mostly about a 3-4/10 burning pain in both eyes. Airconditioning seems to have excacerbated my condition. I work in the hospital as a RN and have had many sick days this summer d/t my condition as the air conditioning is on full blast in the hopital.

Can exposure to airconditioning permanently make eyes drier? Is there a lens you can recommend to help aid moisture to my eyes? ( I refuse to where contacts for vanity purposes anymore, I will only where them to help stop this pain)...thank you so much for your time.

[DrG]

Dry eyes are a risk factor for GPC via increased friction between the eyelid and the contact lens, but I'm not sure what the mechanism would be for GPC-induced dry eye. Possibly some goblet cells on the palpebral conjunctiva would be damaged by repeat episodes and scarring, but I really don't know. But more to the point is whether another contact lens can help alleviate the discomfort without precipitating another case of GPC.

Air-conditioning can help the allergies, but it doesn't do the dry eyes any good at all because of the lower humidity. I might also suggest some form-fitting eyewear to keep out the drafts. Can I assume that you are being treated for the dry eye and evaluated for plugs?

I might be inclined to try a Proclear lens instead of a silicone-hydrogel. Silicone-hydrogels have been implicated with an increased risk of GPC. Naturally, adequate use of artificial tears would be necessary to keep the lenses lubricated.

[Emma3587]

Yes I am being treated for Dry eye, I am having permanant plugs put in today infact (smart plugs), the dissolvable plugs seemed to marginally help.

Lubricating drops only help mildly, sometimes it feels they are worse with increased use of moisturizing drops.

Will proclear lenses dry out my eyes more? I will only wear lenses if it helps my dry eye symptoms, Thanks again for your advice and explaination re: the goblet cells, that makes sense...

I've heard pregnancy can induce dry eye symptoms, do you know if this is permanent?...thanks again for your time....Emma

[DrG]

Emma, after nearly 25 years in practice fitting contact lenses, I long ago came to the conclusion that being post-partum seems to trigger the onset of dry eyes in many women, and for some it is permanent.

The Proclear lenses are high water, and can dry out. However, they tend not to aggravate the papillary conjunctivitis as much as the silicone-hydrogel lenses. It's basically trial and error at this point.

From the sound of it, you have many allergies. Have you tried a mast cell stabilizer such as Alocril? As it is not an antihistamine, dryness should not be a problem. From my experience, patients with allergies tend to do better with Proclear lenses.

[Emma3587]

Thank you so much for your time Dr G, I will take your advice . Emma

[Emma3587]

In the meantime (while I get the allergies and/or dry eyes under control) do you think I could benefit from the soft bandage contacts I have heard you mention serveral times on this site? (Given my situation?)

Or could they possibly exacerbate my GPC condion?

[DrG]

The term "bandage lens" refers not so much to the brand or type of lens, but describes the purpose for which it is worn, i.e. therapeutic as opposed to cosmetic. Eye doctors typically pick whatever disposable lens they have on hand. I tend to be a bit more selective, and since the lenses are likely to be worn 24/7, I now use the Focus Night and Day or other silicone hydrogel lens because of the oxygen permeability. I have also used Proclear Compatibles.

With a dry eye, friction between your inner eyelid and the dry lens can incite the formation of papillary conjunctivitis. There have been literature reports of an increase in the incidence of GPC with silicone hydrogel lenses, probably due to the surface characteristics of the silicone-based polymer, which has to be treated to increase wettability. Not everybody with dry eye gets GPC, but since you have it, I would avoid anything that might potentially aggravate it until you have found the right therapy.

You should first find a way of treating your eye condition without the use of drying antihistamines. I suggested using a mast cell stabilizer, such as Alocril. You can also use a topical steroid short term to bring the inflammation under quicker control. Staying out of lenses will hasten the resolution, and so I would take about a 6 week vacation from them. Then, once you have made some strides in treating the allergies and the dry eye, try using the Proclear Compatibles, which have an ultra-slick, low deposit surface. Never sleep in your lenses if you have a history of GPC.

Many people with GPC do well with a daily disposable. But, if you have dry eye, they will only make your eyes feel worse.

[Emma3587]

Yes, have stayed out of my lenses for a year now. And have been on/off pred minimims during this time. Maybe Alocril will help... although I googled it and one of the side effects is conjunctivitis itself....kinda scares me because I can't imagine feeling any worse than I do....

Wondering if I might have CES?....have heard you speak about it on this forum....I was in quite a lot of pain and used to push my contact lenses....I doubt I will ever where them again...

Thanks again for your time, you sound like a very caring Dr who is passionate about his work...I wish there were more like you....