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 seemed 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. 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 隱形眼鏡 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 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 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 incidence started climbing again.