Therapeutic Forum |
Brush Up Your GPC ManagementChristopher J. Quinn, O.D.In the glamour of today’s focus on refractive surgery, many of us have failed to notice that the rate of complications associated with contact lens wear seems to have fallen off significantly. The reason we’re getting fewer referrals to our sub-specialty optometric center these days may be because O.D.s in our area generally can manage whatever complications do occur. Yet, it seems safe to say that the rate of what had been one of the most common complications associated with soft lens wear has diminished. A patient would come into your office complaining of increasing contact lens intolerance, decreased wearing time, increased lens movement and significant mucus discharge frequently coating the contact lens. In the past, this was not uncommon. Today, we’re hearing less of this type of complaint. The symptoms the patient described were also accompanied by conjunctival injection. Eversion of the upper lid revealed the presence of a significant giant papillary response. Clinicians and researchers have debated the etiology of such reactions. They’ve cited both allergic and mechanical factors in the development of giant papillary conjunctivitis. Treatment options were limited. The best way to relieve the symptoms was to discontinue lens wear. Cromolyn sodium 4% (Opticrom, Crolom) drops helped many patients. Steroids could be effective in extreme cases but limited the patient’s ability to continue lens wear. Today, the incidence of GPC has diminished significantly. At least one retrospective study has identified frequent replacement of contact lenses as an important variable in this trend.1 Patients who replaced their lenses on a daily or 3-week cycle had a much lower risk of developing GPC than those who replaced their lenses less often. The increasing use of disposable and frequent replacement contact lenses regimes helps explain the decrease in this common contact lens-related complication. Today we also have many more tools to fight GPC when it does occur. Besides Opticrom and Crolom, we have a host of other agents which act to stabilize the mast cell wall. They also inhibit the release of the inflammatory mediators that are thought to be a cause of GPC. Alomide (lodoxamide 1%), and Alamast (pemirolast potassium 0.1%) both act to stabilize the mast cell. Mast cell stabilizers take several weeks to reach maximum effect. Patients should use them for at least 3-4 weeks. In addition to the mast cell stabilizers, several new medications with multiple mechanisms of action can be useful in treating GPC. Alocril (nedocromil sodium 2%), Zadator (ketotifen fumarate 0.025%) and Patanol (olopatadine hydrochloride 0.1%) have both antihistamine and mast cell-stabilizing properties. They may be useful in treating patients who complain of significant itching associated with their contact lens wear. The antihistamine components of these medications generally have a rapid onset of action and can relieve symptoms quickly, while the mast cell stabilizing action occurs on a longer-term basis. Although you should reserve the use of topical steroids for the most severely symptomatic patients, Alrex (loteprednol etabonate 0.2%) has good anti-inflammatory properties and is less likely than other steroids to cause elevated intraocular pressure. Use this for patients who need prompt relief from advanced GPC. They must discontinue lens wear while using a topical steroid to treat any condition. The more we can do to make contact lens wear more comfortable for our patients, the better. By keeping an eye on indicators for problems like GPC, we can guarantee a higher success rate for satisfied contact lens wearers. We might not see GPC as frequently as we once did, but we must be ready for it anytime it comes in the door. 1. Donshik PC, Porazinski AD. Giant papillary conjunctivitis in frequent replacement contact lens wearers: a retrospective study. Tr Am Ophthalmol Soc 1999;97:205-216.top |
| © Review of Optometry OnLine
July 15, 2000 |