Contact lens-related Fusarium infection: Case series experience in New York City and review of fungal keratitis

PURPOSE. To report and define the clinical presentation, hygienic practices, treatment regimens, and visual sequelae of contact lens wearers infected with Fusarium keratitis in the New York City metropolitan area and to review the literature on Fusarium keratitis. METHODS. A retrospective chart review was conducted on three patients diagnosed with Fusarium keratitis by corneal fungal culture in the New York City metropolitan area from October 2005 to February 2006. None of the patients had a history of recent ocular trauma before infection. RESULTS. All three patients used disposable soft contact lenses and ReNu with MoistureLoc 1 month before infection. All patients experienced a unilateral stabbing pain of the affected eye after removal of the contact lens. Patients had corneal ulcers ranging from 1 to 5 mm in diameter and were all initially treated with topical antibiotics and steroids for a period between 7 and 52 days. Antifungal treatment was eventually prescribed to all patients, with topical natamycin 5% every hour being the most common. One patient required corneal transplantation, and the other two patients recovered visual acuity comparable to their baseline acuity. CONCLUSIONS. A delay in diagnosis and prolonged treatment delay of Fusarium keratitis is associated with significant comorbidity. Physicians must have a higher index of suspicion for fungal keratitis in contact lens wearers to facilitate in early diagnosis and treatment.