Alternaria and Paecilomyces Keratitis Associated with Soft Contact Lens Wear

Purpose: To report a series of 5 patients with soft contact lens (SCL) related fungal keratitis caused by unusual organisms diagnosed at the Wills Eye Institute, Cornea Service in 2008.

Methods: Chart review of patients with SCL related Alternaria and Paecilomyces keratitis diagnosed in 2008 was performed. Causes of these fungal infections were compared to previous years.

Results: During a period from 1999 to 2007, among 64 patients with fungal keratitis, Alternaria was isolated from one case after corneal foreign body removal in 2004, and Paecilomyces was not isolated in any of these patients. In 2008, however, 5 patients with SCL-related atypical fungal keratitis were diagnosed. Alternaria was isolated from 2 cases and Paecilomyces from 3 cases. All patients wore Acuvue SCL (Johnson & Johnson Vision Care): Acuvue Oasys, Acuvue Advance, and Acuvue 2 (1 case each) and Acuvue unspecified (2 cases). A total of 2 patients with Alternaria and 1 patient with Paecilomyces used ReNu or a generic-brand solution manufactured by Bausch & Lomb; 2 with Paecilomyces keratitis used Opti-free Replenish solution. A total of 3 patients wore lenses for daily wear and 2 wore them occasionally for overnight wear. The patients were treated with either voriconazole drops alone or combined with voriconazole 200 mg pills or Natamycin 5% drops. Three patients responded well to treatment. One patient with Paecilomyces keratitis developed a corneal perforation managed with tissue adhesive. One Paecilomyces keratitis patient required an emergency penetrating keratoplasty because of a perforated corneal ulcer present at the initial examination.

Conclusions: We report 2 cases of Alternaria and 3 cases of Paecilomyces keratitis in patients wearing frequent replacement lenses and using multipurpose solutions diagnosed during 2008. We want to raise awareness of fungal keratitis caused by unusual organisms associated with SCL wear.