N O T E S , C A S E S , I N S T R U M E N T S 307

McLean, Ε . M.: Intra-abdominal cystic calcification of unusual aetiology and presentation. Proc . Mine Med. Office Α. , 39:33-35, 1959.

Strong, R. P . : Stitt's Diagnosis , Prevent ion and Treatment of Tropical Diseases . Philadelphia, Blakis-ton, 1944, ed. 7.

CONTACT L E N S CORNEAL ULCER

J. R O B E R T F I T Z G E R A L D , M . D .

Oak Park, Illinois

W E N D E L L K A P U S T I A K , M . D .

Chicago, Illinois

A N D

J A M E S L. M C C A R T H Y , M . D .

Oak Park, Illinou

Corneal ulcer associated with the wearing of a contact lens is an uncommon, though serious, complication. It follows abrasion and concurrent contamination of the af-fected cornea by micro-organisms, common among which is Pseudomonas aeruginosa.

R E P O R T O F C A S E

W . U. , a 22-year-old myopic man, w a s first seen by one of us ( W . K . ) on September 26, 1959, with an ulcer of his left cornea. One week prior to this whi le playing football (and wear ing contact lenses) his left eye w a s injured by an elbow. H e noted no immediate discomfort and continued playing foot-ball and attending school. Over the next f ew days he experienced epiphora without pain, removing and replacing the lens several times a day. S i x days after the injury the eye became painful and red.

Examinat ion showed a s ix-mm. central corneal ulcer with irregular margins and a soft base. A large amount of purulent drainage w a s noted.

H e w a s treated with systemic erythromycin and penicillin and topical polymyxin, neomycin and bacitracin. Twenty - four hours later the ulcer w a s larger and thinning of the central stroma w a s noted. A f t e r t w o days of this therapy the ulcer showed no s ign of improvement so systemic griseofulvin w a s added to the regimen. Short ly after this, the condi-tion showed marked improvement and by October 4, 1959, the ulcer was healed but a dense, minimally vascularized leukoma formed reducing his vision to 20/200 (fig. 1 ) .

In September, 1960, a successful seven-mm. penetrating keratoplasty w a s performed on his left eye. H i s postoperative course w a s uneventful and at present uncorrected vision of his lef t eye is 2 0 / 3 0 (fig. 2 ) .

C O M M E N T

Though the corneal type of contact lens has evidently found its niche in ophthalmo-

Fig. 1 (Fitzgerald, Kapustiak and M c C a r t h y ) . P r e -operative appearance of leukoma. Vis ion 20/200.

logic treatment, it carries with it some ele-ment of risk of which all prospective contact lens wearers should be made aware. Theo-retically there should be no contact with the cornea, the lens gliding evenly on the pre-corneal tear film. However this may be, we are all familiar with the punctate staining of the corneal epithelium seen in many patients wearing contact lenses. Thus, in most pa-tients sites of entrance for micro-organisms exist. Fortunately, the cornea, under these circumstances, apparently can tolerate cer-

Fig . 2 (Fitzgerald, Kapustiak and M c C a r t h y ) . Appearance after penetrating keratoplasty. Vis ion 20/30 .

308 N O T E S , C A S E S , I N S T R U M E N T S

tain organisms without dire results. But given the proper set of circumstances—an adequate number of virulent organisms and a decrease in corneal resistance—the chain of events leading to a corneal ulcer can oc-cur.

The pathogenesis of the ulcer of this pa-tient most likely included an initial abrasion followed by contamination with a virulent bacteria or a fungus. From the appearance and location of the leukoma the most likely etiology was Pseudomonas aeruginosa. The possibility exists that a foreign body lodged between the contact lens and the cornea and that the ulcer followed secondary infection at the site of the foreign body.

Corneal ulcers can occur under other cir-cumstances, for example, contamination of the wetting solution and from poor personal hygiene. Whether contact lenses are best stored dry or wet is debatable. There are those who maintain that the danger of Pseu-domonas aeruginosa infection is lessened if lenses are stored dry, but this is countered by those who feel that a dehydrated lens is irritating to the cornea. Because of the hy-drophilic properties of modern contact lenses continued immersion is necessary to main-tain proper hydration. Ulcers may also fol-low use of a lens in the presence of local lid, conjunctival or corneal disease and in de-bilitated states of the patient wherein re-sistance is lowered. Contact lenses are best kept off the patient in such condition^.

Corneal ulcer is a rare complication of contact lenses. The common complications are (1 ) corneal abrasion, (2 ) acute corneal edema, (3 ) superficial punctate keratitis and

(4) thickening of the corneal stroma. These follow wearing an improperly fitted lens or wearing the lens too long or too irregularly.

Over the past five years, we have been able to find two reports of corneal ulcer as-sociated with wearing of a corneal contact lens. Payrau and Perdriel1 (1956) reported bilateral corneal ulcers with hypopyon fol-lowing continuous wearing of contact lenses. Heydacker2 (1958) reported a corneal ulcer following wearing of a contact lens. Lansche and Lee 3 (1960) reported on the acute com-plications from corneal contact lenses in 14 cases. They observed no ulcers in their group, though it is interesting that they cul-tured Escherichia and hemolytic Staphylo-cocci in two patients with corneal abrasions. Allen 4 (1960) related his personal experi-ence with this problem. He has treated a Pseudomonas aeruginosa ulcer associated with wearing of a corneal contact lens.

S U M M A R Y

While wearing a corneal contact lens and playing football, a patient sustained blunt injury to his eye. A corneal ulcer with sub-sequent leukoma required a penetrating keratoplasty to restore his vision. The mech-anism of production of corneal ulcers while wearing contact lenses is discussed. The pre-vention of this complication entails selective choice of patients, wearing a properly fitted lens and excellent personal hygiene. This and other serious complications of corneal contact lenses should restrict their use to carefully selected patients.

6429 West North Avenue. 3451 West 63 Street.

R E F E R E N C E S

1. Payrau, P , and Perdriel, G.: Bilateral hypopyon ulcer of the cornea fol lowing the continuous wear-ing of contact lenses. Bull. Soc. ophtal. France, 9:852-854, 1956.

2. Heydacker: Ulcus cornea nach Haf tg las . Klin. Monatsbl. f. A u g e n h , 133:588, 1958. 3. Lansche, R. K , and Lee, R. C : Acute complications from present day corneal contact lenses. Α Μ Α

Arch. O p h t h , 64:275-285 ( A u g . ) 1960. 4. Allen, H . : Pseudomonas aeruginosa and Staphylococcus aureus: A study in contrast. Proc. Chicago

Ophth. S o c , N o v , 1961.