Whether this recent outbreak of infections is caused by a new strain of fusarium, or is the result of other factors, is also under investigation by the CDC
By: Andrew Lipka, M.D., in collaboration with Gloria N. Beck
If you are one of the more than 30 million Americans who wear soft contact lenses, you should be aware of a recent outbreak of fusarium keratitis, a fungal eye infection that can cause irreparable damage to the cornea and, if not properly treated, blindness.
Severe infections of the cornea, the transparent membrane covering the iris or colored part of the eye, are not very common. Individuals who wear soft contact lenses, however, are at higher risk for such problems. Poor hand-washing practices, improper lens care and wearing contact lenses longer than recommended (i.e.. overnight) can facilitate the growth of germs and bacteria increasing the likelihood of infection.
Typically, severe corneal infections are bacterial in nature. While they can be serious, if promptly diagnosed and aggressively treated with antibiotic drops, recovery from these infections is possible.
This recent outbreak of eye infections is unique, and of particular concern, because it is caused by fusarium, a type of fungus. Fusarium is typically found in plants and soil in tropical regions of the world. The fungus enters the cornea through a small tear or abrasion on the surface and then grows within the cornea. The condition is quite painful and, without treatment, or in some cases, despite treatment, can scar the cornea resulting in significant vision loss.
The symptoms of fusarium keratitis sudden blurred vision, pain or redness, increased light sensitivity, a discharge and lesions on the iris mimic those of a bacterial infection in its earliest stages. This can complicate diagnosis, further delaying treatment.
In addition, because the infection is rare, the only conventional medication to treat fusarium keratitis natamycin drops is not routinely stocked in pharmacies and can be difficult to obtain. Natamycin may prove inadequate on its own, necessitating the "compounding" of powerful, customized medications, with high levels of toxicity.
The Centers for Disease Control (CDC) has, to date, received reports of 186 suspected cases from 29 states several in New Jersey. Of these, 73 have been confirmed as fusarium. Virtually all of those affected were soft contact lens users. Of those who could recall, most used the same brand of solution to disinfect their lenses Bausch & Lomb’s "ReNu with Moisture Loc," a relatively new formulation introduced in 2004.
It’s important to note that no evidence of any contamination in this particular contact lens solution or in Bausch & Lomb’s production facilities has been found, and no one is alleging that the company is responsible for this outbreak.
However, while the CDC and Food and Drug Administration (FDA) investigate this infection, Bausch & Lomb, in the interest of public safety, has voluntarily stopped shipping the product to U.S. and Asian markets, and many local pharmacies and grocery stores have removed the product from their shelves.
Prior to the unusual rise in this infection in this country, 39 cases of fusarium keratitis were also reported in Singapore and Hong Kong in February. These cases showed a similar pattern of use of ReNu with Moisture Loc solution.
Whether this recent outbreak of infections is caused by a new strain of fusarium, or is the result of other factors, is also under investigation by the CDC. In the meantime, if you wear soft contact lenses, you can help prevent eye infections and protect your sight by taking extra precautions with contact lens use and care.
First and foremost, always wash and dry your hands with a lint-free cloth before handling contact lenses or touching your eyes. Carefully and regularly clean your lenses using fresh disinfecting solution each day. No matter what type of disinfecting solution you use, always gently rub the lenses to ensure adequate disinfection even if your product is a so-called "no rub" solution.
Never use saliva, tap water or homemade saline solutions to moisten or clean your lenses. Be sure to store your lenses in a proper lens storage case. Keep the lens case clean by emptying it, washing it out, and air-drying it between uses, and change your case every three months. Always replace contacts on time don’t try to stretch another week out of them. Do not wear lenses overnight at this point, even if they are approved for such wear.
Fusarium keratitis is an extremely serious fungal infection. Of the initial confirmed cases in this country, eight of those infected so far have sustained sufficient damage to the eye that required corneal transplants. It is also significant to note that many of these individuals recalled wearing their contact lenses overnight a factor known to increase the risk of serious corneal infection by as much as 13 times.
If you wear soft contact lens and notice a sudden change in your vision, pain or redness, increased light sensitivity, a discharge or white lesions on the colored part of your eye, seek immediate medical treatment from your eye care professional.
In addition, if you have an eye infection that isn’t responding to antibiotic treatment, ask your doctor about fusarium keratitis. While the risk of contracting this fungal infection appears to be relatively small, taking the necessary safety precautions, learning the symptoms and recognizing when to seek prompt medical attention for your eye care concerns are key to helping you maintain good eye health and protect your sight.
For more information on fusarium keratitis, please visit the CDC Web site at www.cdc.gov. To find a Princeton HealthCare System ophthalmologist, call (888) 742-7496.