RESEARCH REVIEW
Loretta B. Szczotka-Flynn, OD, PhD, MS, FAAO

A Reminder About Fungal Keratitis

As the old saying goes, "out of sight, out of mind." However, we should not get complacent in considering the possible involvement of fungal species in atypical contact lens infections. A recent publication (Edelstein 2011) reported on a case of resistant contact lens associated Fusarium keratitis progressing to endophthalmitis and eventual enucleation. A 52-year-old soft contact lens wearer in the U.S. had a corneal abrasion and developed a corneal infiltrate. Examination of corneal scrapings revealed filamentous hyphae with septation and conidia. Despite aggressive antifungal therapy with topical natamycin, amphotericin B, and systemic fluconazole, the keratitis progressed, and repeat penetrating keratoplasties, intravitreal amphotericin B injections, and pars plana vitrectomies were performed. The culprit was a multidrug-resistant Fusarium solani species complex, which is extremely rare.

Other recent Fusarium keratitis case reports can be found on PubMed. A 2010 report from Croatia presented a Trichophyton spp. fungal ulcer in a 22 year old contact lens wearer (Mravicic 2010), and a 2011 report from Korea (Byun 2011) reported on a fungal infection which developed after (and was masked by) application of fibrin glue in an infectious corneal ulcer.

Clinicians should remain alert for potential fungal infections in contact lens wearers; although they are rare, they can result in devastating consequences.

Byun YS, Kim MS. Superimposed fungal ulcer after fibrin glue sealant in infectious corneal ulcer. Korean J Ophthalmol. 2011 Dec;25(6):447-50. Epub 2011 Nov 22.
Mravicić I, Dekaris I, Gabrić N, Romac I, Glavota V, Sviben M. Trichophyton Spp. fungal keratitis in 22 years old female contact lenses wearer. Coll Antropol. 2010 Apr;34 Suppl 2:271-4.
Edelstein SL, Akduman L, Durham BH, Fothergill AW, Hsu HY. Resistant Fusarium Keratitis Progressing to Endophthalmitis. Eye Contact Lens. 2011 Oct 8. [Epub ahead of print]