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MEDICINE | A CLOSER LOOK: INFECTIONS AND CONTACT LENSES

As fungus cases are studied, keep your own eye hygiene clean

April 24, 2006|Janet Cromley

On April 13 Bausch & Lomb asked retailers to temporarily halt sales of its ReNu With MoistureLoc contact lens solution. The announcement came after the Centers for Disease Control and Prevention reported that it was investigating 109 suspected or confirmed cases of Fusarium keratitis, occurring over 10 months. (Since then, the number has risen to 176.) Fusarium keratitis is a potentially serious infection of the cornea. Of the 30 cases reviewed by the CDC to date, 28 involved contact lens wearers. Twenty-one reported using ReNu brand products, and five reported using a combination of ReNu and products made by other companies.

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Janet Cromley

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Fusarium keratitis is usually caused by a group of fungi referred to as the Fusarium solani species complex. Although the condition is more common in tropical and subtropical environments, these fungi can be found just about anyplace. They are present in soil and even homes, where they generally cause no apparent harm.

Historically, Fusarium keratitis has been most often associated with situations in which either soil or some type of organic matter has come into contact with the eye at the point of an abrasion, says David Geiser, director of Pennsylvania State University's Fusarium Research Center.

An example would be someone working in a field who gets soil in his eye. If fusarium is in the soil and the eye becomes abraded, the fungus can attach to the cornea.

Symptoms of Fusarium keratitis include redness or irritation of the eye, blurred vision, tearing, excessive discharge and sensitivity to light.

The condition is sometimes mistaken for a bacterial infection and treated with topical steroids, which only worsens the condition. Misdiagnosis can be prevented by culturing scrapings from the cornea.

Fusarium keratitis is considered serious because although very rare, it can cause extensive damage to the cornea. The infection and inflammation work in concert to create a one-two punch that can, in some cases, create a hole in the cornea. Untreated, the infection can lead to blindness. Early treatment includes topical and oral antifungal medications. Those who do not respond may need surgery, including corneal transplantation.

It's unclear how lens cleaning solution is linked to fungal keratitis. Dr. David Hollander, an ophthalmologist at UCLA's Jules Stein Eye Institute, thinks that the simple act of inserting and removing the contact lens might create a microtrauma. This could provide a point of entry for the fungus, which can grow on lenses and lens cases.

"Typically," he says, "patients getting the fungal ulcers have poor contact lens hygiene, meaning they might be keeping disposable lenses around for months, or not changing their lens case, or they're sleeping in their contact lenses."

If there's a silver lining to the outbreak, he says, "it may be that it reminds contact lens wearers to follow normal precautions in cleaning and handling their lenses."

Here are a few guidelines for contact lens care:

Always wash your hands before handling lenses; clean and store lenses as directed by the package instructions or by your healthcare provider; clean the contact lens case after each use; keep the lens case open and dry between cleanings; replace the case every three months; and use only fresh solution to clean and store lenses.

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