Six Signs You May Have Giant Papillary Conjunctivitis From Your Contact Lenses
- Itchy eyes as contact lenses get older
- Lenses that slide and stick under the upper eye
- Irritation Every Time You Blink
- Mucous Discharge and Foggy Vision
- Lenses That Discolor and Develop a Film
- Intermittent Red Eye With Feeling Something is Scratching Your Eye
In the early years of soft contact lenses there was one choice – the initial Soft Lens. The cost of a single pair of these miraculous new soft, comfortable lenses was between $ 300 and $ 400 when first introduced in 1971. Accounting for inflation, today that would be almost $ 2000. There was a very strong financial incentive to make the lenses last as long as possible. Using enzyme cleaners and sending lenses off for a special factory cleaning were common procedures.
Lenses were often used for 3 to 4 years until they were yellowed and covered with numerous deposits from components of the tear film. Lipid bumps, calcium and mineral deposits, protein deposits and frequent tears and little missing chunks of the lens edges were tolerated well past the healthy tolerance of the eyes. A new eye problem begin to show up in a number of the wearers of these new soft contact lenses.
As lens technology progressed and prices came down lenses were replaced more frequently and the mystery red eye syndrome appeared to drop off. Then in 1981 the first contact lens for over night wear was approved and the era of extended wear contact lenses had began. Cases of this new eye problem started to show up again and became common enough to recognize and diagnose.
The typical patient would come in to see the optometrist complaining about eyes that were red and irritated, possibly itching, and contact lenses that would slide around on the eye, sometimes falling out with blinking. On further questioning the lenses usually were sliding up as they would occasionally adhere to the underside of the upper eyelid. Often there would be some clear mucous or discharge from the eye, and some contact lens wearers would tell their eye doctor that they were seeing little spots on the surface of the lenses when they were handling them.
People have often admitted to me that they turned their upper eyelids inside out as kids. For some unknown reason, girls more than boys, at least by admission. What was found in the 1980's when inverting the upper eyelid is now referred to as Giant Papillary Conjunctivitis. There is a clear tissue that covers the white part of your eye and extends underneath the eyelids as their surface lining. In Giant Papillary Conjunctivitis, giant papillae (bumps of swollen tissue) form under the upper eyelid. These are described as giant but actually are about 1/3 millimeter in diameter. They do feel great due to the highly sensitive nature of the clear tissue on the front of your eye, the cornea. Every blink rubs these bumps across the cornea and creates discomfort.
The cause of Giant Papillary Conjunctivitis has been disputed for years but most eye care providers agree there are two components: a mechanical irritation and an immunological reaction.
The lens edge constantly engages the underside of the eyelid with each blink that results in a form of low grade irritation and inflammatory reaction in a small percentage of contact lens wearers. There are probably multiple reasons such as how taunt or floppy the lid is, how the secretions make it more prone to slide over or stick to the lens, the variations in lid curvature that apply pressure to the lens at different areas, and if the conjunctiva Tissue has a higher number of inflammatory mediators already present. Deposits on the lenses can also cause a mechanical type of reaction.
The immunological reaction is related to deposits that build up on the lenses. These can be your own tear lipids, proteins, preservatives in contact lens solutions that build up in the lens matrix, environmental allergens that build up on the lens, and in rare cases possibly the material the lens is made of. Since soft lenses are about half water they act like a sponge absorbing larger molecules and retaining them resulting in increasing levels over time.
Wearing the same pair of lenses for several years obviously caused an increase in this condition. The hard lenses worn prior to soft contact lenses can still cause Giant Papillary Conjunctivitis, but because they are inert and do not absorb any water the incidence is very low. With the advent of extended wear, the eyes were given constant exposure to the mechanical and immunological irritants with no recovery time so the incident started climbing again.
In the first era of contact lens technology lenses were frequently machined on a lathe when dry then re-hydrated. Today automation and molding manufacturing techniques allow for much more precise and smooth lens edges. Lens that were hand inspected under a microscope in the past are now quality controlled by automated systems. There have been quantum improvements in lens quality that have helped decrease lens edge induced problems. Extended wear contact lens materials are starting to be designed today to help resist deposits better. For a number of years now the major contact lens manufacturers have been using large molecule preservatives that exceeded the pore size of soft contact lenses. This greatly reduces the possibility of toxic preservatives inside the lens over time. Unfortunately, many generic solutions appear similar but often contain the older small molecule preservatives that can lead to Giant Papillary Conjunctivitis.
Even though the occurrence is much lower today, Giant Papillary Conjunctivitis can still be a major eye irritant and contact lens problem. There are several approaches to managing Giant Papillary Conjunctivitis. Switching to daily disposable lenses eliminates coating reactions completely since the lenses are thrown away daily and never exposed to disinfecting solutions. Usually, contact lens wearers with Giant Papillary Conjunctivitis have been wearing their contacts well beyond the recommended replacement cycle and become lax in cleaning the lenses. Returning to a normal 2-4 week replacement cycle and discontinuing or decreasing overnight wear may be all that is required to return the eye to normal health.
Prescription eye drops are also a large part of treating Giant Papillary Conjunctivitis .. A class of eye drops called mast cell stabilizers work to stabilize the cells membranes from releasing histamine that starts the inflammatory cycle. These eye drops are very safe and can be used year round when needed. Other options are available and today Giant Papillary Conjunctivitis is no longer the end of your contact lens career, only a small bump in the (eye) road. Vision insurance plans services frequently offer options that include medical treatment for conditions like Giant Papillary Conjunctivitis. You should do an annual review of all of your medical and vision coverage to make sure you are providing the best benefits you can for your family.