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Too Much of a Good Thing

Extreme overwear of a bandage contact lens let this opportunistic inection flourish.
By Christine W. Sindt, OD

5/15/2017

A 74-year-old female with a >20-year history of Sjögren’s syndrome, epithelial basement membrane dystrophy and repeated episodes of recurrent erosions of the left cornea presented with a three-month history of decreased vision, foreign body sensation with discomfort, irritation and photophobia OS. She reported using cyclosporine 0.05% BID. 

She had previously tried a bandage contact lens to help with the discomfort of erosions. Over the previous 10 days, her pain, irritation, visual blur and redness had increased. She saw her primary care doctor for “sinus issues” and was given an oral antibiotic and nasal spray, which aggravated her ocular symptoms. She was told her “eye looks dry.”

On presentation, it was noted that she still had a bandage contact lens in her left eye, of unknown but long duration. The lens was removed, and both it and her ocular surface were cultured. She was empirically started on vancomycin and tobramycin every hour while awake and two times overnight, plus preservative-free artificial tears, pending culture results.

On day seven, her cultures grew positive for Aeromonas species susceptible to the topical medications she was currently taking. Viral and anerobic cultures were negative. Fungal cultures are still pending.

Aeromonas, a gram-negative bacillus known to populate environmental sources, is sometimes found in contaminated hospital water supplies, from which it can lead to nosocomical infections.1 Researchers have cultured it from the intestinal tract of asymptomatic subjects, but it is not part of the normal ocular flora.1 When present, it can lead to opportunistic infection, particularly in immunocompromised individuals.

As this presentation was in her better-seeing eye (the other had severe neurotrophic scarring) and she is a poor candidate for keratoplasty, treatment compliance will be essential to a successful outcome.  

1. Motukupally SR, Archana Singh A, Garg P, Sharma S. Microbial keratitis due to aeromonas species at a tertiary eye care center in southern India. Asia-Pac J Ophthalmol 2014;3: 294-8.




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