Soft Contact Lens Irritatation Eyelid-GPC

Dr. Kisling Contact Lens Problems, Contact Lenses, Eye Allergies, Fort Collins Eye Doctor, Fort Collins Optometrist, Giant Papillary Conjunctivitis-GPC, Pinkeye, Vision Insurance, Vision Service Plan -VSP 8 Comments



  • Itchy eyes as contact lenses get older

  • Lenses that slide and stick under the upper eye lid

  • 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 Bausch & Lomb 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 seemed to drop off. Then in 1981 the Hydrocurve soft contact lenses was introduced as the first contact lens for over night wear, the advent of extended wear contact lenses.  Cases of this new eye problem started to show up again and become 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. Frequently there would be some clear mucous or discharge from the eye, and some contact lens wearers would tell their eye doctor they kept seeing little spots on the surface of the lenses when they were handling them.

People have often admitted to me 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, or GPC. Usually it is referred to as GPC. There is a clear tissue that covers the white scleral part of your eye and extends underneath the eyelids as their surface lining. In GPC, 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 giant 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 GPC 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 GPC, 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 incidence started climbing again.

In the first era of contact lens technology lenses were frequently machined on a lathe when dry then re-hydrated. Bausch & Lomb developed spin casting the liquid material in a mold. 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. These have been quantum  improvements in lens quality that have helped decrease lens edge induced GPC 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 exceed 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 GPC.

Even though the occurrence is much lower today, GPC can still be a major eye irritant and contact lens problem. There are several approaches to managing GPC. 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 GPC have been wearing their contacts well beyond the suggested 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 GPC. 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 GPC is no longer the end of your contact lens career, only a small bump in the (eye) road.  Vision Insurance like Vision Service Plan Frequently offer plans that include medical treatment for conditions like GPC. 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.

Comments 8

  1. Carolyn Schoenburg

    My optometrist diagnosed my eye problem as GPC. Ive had it for months. She didnt prescribe me eye drops however. She said my only option is lasix surgery, but i cant get that right now. Would you recommend zaditor drops, or should i see a different dr for an rx?

  2. Post
    Dr. Kisling

    Hi Carolyn,

    You don’t need LASIK for GPC. If you are wearing soft contact lenses you may need to move to a more frequent replacement cycle and/or take a short break. Zaditor is an option but I believe the prescription drugs in that class work better. Sometimes it takes a steroid drop initially to calm things down. I would recommend you get a second opinion.

    Best Wishes!

  3. Ananya

    I have problem in my eyes caused by using soft contact lenses. The papillea were romoved surgically many times but they reappeared.
    Now I have been told to use eye drops viz Tears Naturalle II (Hypromellose Opthalmic Sol) I haven’t worn contact lenses for past 5 years but still my problem persists. Please help me. I am from India. Here doctors say there is no treatment for this problem which is very disappointing.

  4. Ryan

    Is GPC the same as general ‘deposits’ under the eyelid? I was recently told I have deposits under my eyelids after feeling like I had an eyelash or a particle in my eye. I was given antibiotics and zatidor. A month later it happened again. Another bottle of antibiotics and zatidor. Now, a month after that I’m back again doing the same thing. I cannot wear glasses but I am pretty much unable to see without lenses. Glasses always make me sick and worsen my vertigo problems for some reason. I can’t imagine what I will do if this keeps up. I can’t afford lasik. What a nightmare. I just want to see and not be in discomfort anymore! 🙁

  5. Post
    Dr. Kisling

    Hi Ryan,

    It sounds like GPC but you would have to ask your doctor to be sure. Usually you don’t need antibiotics for GPC so maybe it was an infection? Zaditor is OK for GPC but not the best drug to use. It is the most cost effective. I am presuming you were wearing contact lenses? If so, going to a daily disposable lens might be a great option for you.

    Best WIshes!

  6. Post
    Dr. Kisling

    Hi Ananya,

    You may have an allergic condition like vernal conjunctivitis. Steroid and mast cell stabilizer eye drops might be needed. Sometimes cyclosporine is used as are oral antihistamines. Ask your doctor if these will help. Moving to a colder climate might also give you some relief.

    Best Wishes!

  7. Darrell

    I have wore soft lenses for 18 years problem free, three years ago I wore a set of monthly disposable lenses for three months. I developed bumps in my left upper eyelid making it not possible to wear lenses. My eye doctor had me wear glasses for 3 months and switch to daily disposables. This worked for 8 months and the bumps came back in the same eye. Went to different eye doctor, wore glasses for 3 months, switched to different Lense brand and used Zaditor eye drops. 8 or 9 months later bumps on left upper eye lid again, please give me your professional opinion. Thanks

  8. Post
    Dr. Kisling

    Hi Darrell,

    Sometimes a daily disposable does the trick and sometimes switching the material does the trick. Zaditor is not the best drug in that category to use but it can help. Since you have failed to improve you might want to think about trying a scleral rigid gas permeable contact lens. It is very rare to develop GPC, the condition you have, when wearing a gas permeable material. The scleral design is a large lens but oddly enough it tends to be very comfortable unlike the typical gas permeable contact lens.

    Best Wishes!

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