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Fungal keratitis in contact lens wearers
K R Wilhelmus1, N M Robinson, R A Font
1Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas.
Abstract:
In a retrospective review from 1972 through 1987 of patients with microbial keratitis, fungal infection occurred in four (4%) of 90 cosmetic or aphakic contact lens wearers and in four (27%) of 15 patients using a therapeutic soft contact lens. Predisposing factors included improper lens care by the refractive lens wearers and a chronic epithelial defect with topical corticosteroid use among the therapeutic lens wearers. The responsible organisms in the refractive lens group were Fusarium solani (two patients) and Cephalosporium and Paecilomyces (one patient each), and in the therapeutic lens group Candida (three patients) and Aspergillus (one patient). Filamentous fungi were more likely to be associated with cosmetic or aphakic lens wear, whereas yeasts were more frequently found with therapeutic lens use.
Insights
Fungal keratitis is more common in therapeutic soft contact lens wearers than cosmetic lens wearers. Improper lens care and chronic defects with steroid use are key risk factors for this serious eye infection.
Area of Science:
- Ophthalmology
- Microbiology
Background:
- Microbial keratitis is a significant cause of vision loss.
- Contact lenses, both cosmetic and therapeutic, are associated with an increased risk of microbial keratitis.
Observation:
- A retrospective review (1972-1987) analyzed 105 patients with microbial keratitis related to contact lens wear.
- Four (4%) of 90 cosmetic/aphakic contact lens wearers and four (27%) of 15 therapeutic soft contact lens users developed fungal infections.
Findings:
- Improper lens care was a predisposing factor in cosmetic/aphakic lens wearers.
- Chronic epithelial defects with topical corticosteroid use were noted in therapeutic lens wearers.
- Filamentous fungi (Fusarium, Cephalosporium, Paecilomyces) were more common in cosmetic/aphakic lens wearers.
- Yeasts (Candida, Aspergillus) were more frequently associated with therapeutic lens use.
Implications:
- This study highlights the differential risk of fungal keratitis based on contact lens type and usage.
- Emphasizes the importance of proper contact lens hygiene for all wearers.
- Suggests specific etiological patterns associated with cosmetic versus therapeutic lens-related fungal keratitis.