on a case of a contact lens lodged in the eye for more than
a decade
Contact lenses being ‘lost’ in the eye are sadly commonplace in modern optometric practice. In most cases a lens is in the eye only for a few days at most and there rarely is any damage done. However, there are cases of lenses inducing keratitis.1 There has already been a report of a lens being embedded in the eye for 10 years, though this was as a result of trauma2 and quite significantly different to this case that we report here. In this account, we characterise a contact lens, which we believe has been in the eye for at least 10 years and we provide reasons why we hypothesise this to be the case.
Patient history
The patient was a 70-year-old man who was a contact lens wearer prior to having successful bilateral cataract and intraocular lens surgery in 2005. Further to having surgery, the patient did attend for regular eye examinations, however, records are not available for this period as he attended another practice. He maintained he stopped wearing contact lenses shortly before having his cataract surgery in 2005 and does not recall any lost lenses around that time. Spectacles only have been worn since his surgery in 2005, and of course there is a significant change in prescription resulting in any previous lenses being effectively redundant.
1991 Refraction; R -5.50/-3.00 x 135 (6/9)
L -5.00/-3.00 x 55 (6/9)
Current rigid gas permeable contact lens wearer.
2001 Non-arteritic anterior ischaemic optic neuropathy
2005 Bilateral IOL surgery
2011 Refraction; R +2.50/-2.50 x 125 (6/7.5)
L +1.25/-2.00 x 55 (6/7.5)
Add +2.50 R&L (N5)
2013 Refraction; R +2.25/-2.00 x 125 (6/7.5)
L +1.50/-2.75 x 55 (6/7.5)
Add +2.50 R&L (N5)
2015 Refraction; R +2.25/-2.50 x 125 (6/7.5)
L +1.00/-2.75 x 55 (6/7.5)
Add +2.50 R&L (N5)
Summary of findings
The patient presented with a sore red eye, having been red for around three weeks. He had reported rubbing his eye ‘forcefully’ some three weeks previously. This had resulted in a severe red eye with some discomfort and extremely blurred vision. In an attempt to relieve the discomfort, the patient rubbed his eye gently through his closed eyelid which he says resulted in the vision improving significantly. The redness appeared to worsen and consequently the gentleman consulted his general practitioner. The GP advised that the excessive rubbing had displaced the ‘artificial lens’ and had caused a sub-conjunctival haemorrhage. Carbomer gel was prescribed to reduce the redness and it was suggested that he should consult an optometrist.
At this point he was seen in practice and the rigid gas permeable contact lens was removed from the lower conjunctiva close to the inner canthus. The patient believed he had an abrasion and was astonished when a contact lens was removed from the eye. Careful questioning of the patient told the practitioner that no contact lenses had been worn since prior to the IOL surgery in 2005. He could not recall when he last lost a lens and maintains it was well before his 2005 surgery. At this point the optometrist hypothesised the lens could indeed have been in the eye for at least 10 years. Looking at the lens (figure 1) it was clearly heavily deposited to the extent that it was opaque. The lens was stored dry and in isolation until the analysis was carried out.
Lens analysis
The lens was found to be extremely heavily deposited at that time and as such focimetry was not possible. It was then decided to have a microbiological analysis of the lens by molecular biology methods. Pseudomonas aeruginosa and Escherichia coli were found on the outside surface of the lens although there were no traces on the inside of the lens. There were no traces of Acanthamoeba on either surface of the lens. After the lens had been analysed, it was thoroughly cleaned using Progent (Menicon, Japan). This was done very successfully and the lens power was then analysed using a conventional focimeter. The back vertex power was measured as -5.25DS. This ties in perfectly well with the pre-surgical correction helping to confirm that the lens had, in fact, been in the eye for 10 years or more. The lens material was obviously that of a rigid gas permeable lens as there was some flexibility in the lens.
Conclusions and discussion
There was some doubt if the lens had in fact been in the eye for 10 years. The patient had IOL surgery in 2005 and eye examinations had been carried out at two yearly intervals since. It is highly likely that during the course of a routine eye examination where the patient reports no ocular discomfort that the eyelids would not be everted as a matter of routine. However, as the patient had been seen at the local hospital and another optometric practice records were not available to view. Consequently, we cannot be certain if the eyelids were in fact everted.
The fact that the lens measured as being of a prescription which clearly related to a pre-IOL (2005) prescription confirmed to the authors that the lens had indeed been in the eye for some years. The lens had remained in a relatively sterile condition and the bacteria identified as colonisers were not unexpected. Previous reports confirm a contact lens could be in the eye for months or even years with the patient being unaware of its presence.
Graeme Stevenson FBDO (Hons) CL, David PC MacPhail BSc (Hons), BSc (Hons) and Kirsty C Bidgood BSc (Hons) MCOptom work in community practice in Glasgow.
References
1 Tarafrdar S, Ramamurti S, Ramesh K. Recurrent keratitis due to ‘lost’ contact lenses –CLAE,36 (2013) 101-102
2 E Shenken, Canadian Medical Association Journal (1969) 101,295.