A 45-YEAR-OLD man was seen in the neuro-ophthalmology clinic for evaluation of bilateral involuntary eyelid closure in bright light, which had been occurring periodically for the past 8 years. He had received botulinum toxin injections 7 years earlier at another institution, which he claimed were not effective. He had previously worn soft contact lenses but not for the past 2 years. Findings from his medical history were normal, and he was receiving treatment with trazodone hydrochloride and clonazepam for a psychiatric disorder. His visual acuity was 20/20 OU, and findings from ophthalmic examination were unremarkable; no episodes of blepharospasm or hemifacial spasm were noticed throughout the examination. During the examination the patient complained of a whitish discharge from his left eye occurring intermittently during the past year. No other associated symptoms, including pain, were noted. Findings from further examination revealed an opaque, white mass deep in the lateral canthus (Figure 1). The specimen was sent to the pathology laboratory for analysis. The mass was found to be a calcified, soft contact lens containing sulfur granules and Actinomyces species (Figure 2, Figure 3, and Figure 4). Figure 1. View LargeDownload An opaque, white mass deep in the lateral canthus. Figure 2. View LargeDownload Calcified, soft contact lens. Figure 3. View LargeDownload Sulfur granules present on hematoxylin-eosin stain (original magnification ×100). Figure 4. View LargeDownload Actinomyces species present on Gram stain (original magnification ×100). Comment Cases of lost contact lenses are detailed in the ophthalmic literature. A patient who suffered unilateral ptosis and conjunctivitis from a retained soft contact lens has been described.1 Additionally, numerous accounts of migrating hard contact lenses causing ocular complications have been reported and reviewed in the English-language literature.2 No such cases involving soft contact lenses have been documented. Actinomyces is an anaerobic bacterium that is difficult to grow from cultures but whose long filaments and sulfur granules are distinct with Gram staining. However, it is this appearance that frequently results in its mistaken identification as a fungus. Ocular Actinomyces most commonly cause dacryocanaliculitis but can cause infection in almost any structure.3 We were unable to find any reports of retained soft contact lenses associated with Actinomyces in the literature. Furthermore, we were unable to find literature detailing an asymptomatic ocular colonization of Actinomyces. A recent article, however, described a patient with a retained soft contact lens colonized with Aspergillus that resulted in a conjunctival mass and keratoconjunctivitis.4 Our patient noticed symptomatic improvement on removal of the lens, and he was treated with artificial tears. Several weeks later, the patient confirmed that there was no longer any discharge, and he remained asymptomatic. He did still report a problem with bilateral eyelid closure in bright light but, again, this was not noticed on physical examination and was thought to be psychogenic in nature. We did not feel that the patient's eyelid closure and the presence of the contact lens were related. References 1. Patel NPSavino PJ Unilateral eyelid ptosis and a red eye. Surv Ophthalmol. 1998;14182- 187Google ScholarCrossref 2. Roberts-Harry TJDavey CCJagger JD Periocular migration of hard contact lenses. Br J Ophthalmol. 1992;7695- 97Google ScholarCrossref 3. Francois JRysselaere Not Available Actinomycetic infection. Oculomycoses Springfield, Ill Charles C Thomas Publisher1972;129- 147Google Scholar 4. Perry HDDonnenfeld EDGrossman GA et al. Retained Aspergillus-contaminated contact lens inducing conjunctival mass and keratoconjunctivitis in an immunocompetent patient. CLAO J. 1998;2457- 58Google Scholar
Archives of Ophthalmology – American Medical Association
Published: Apr 1, 2000
Keywords: actinobacteria,contact lenses,microbial colonization
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