Fungal invasion of a therapeutic soft contact lens and cornea

A fungal corneal infection occurred in a 66 yr old man who wore a therapeutic soft contact lens for 12 mth during treatment for a metaherpetic corneal epithelial erosion. The infection was documented by finding positive cultures from both the contact lens and the cornea, and histologic evidence of fungal infiltration of the therapeutic soft lens. The fungus was identified as Cephalosporium acremonium. Pathogenic fungal invasion of soft lenses is unusual. Corneal infections associated with such conditions are rare. This case demonstrates histologically, a pathogenic fungal corneal infection arising from therapeutic contact lens wear. Factors that may influence soft lens infiltration by fungi are: enzymatic activity produced by the fungus; and lens material properties which provide a matrix and a nutrient source for fungal growth. Continuous-wear soft contact lens treatment with topical steroid and prophylactic antibiotics used in combination in an already compromised cornea were thought to be responsible for this complication. A therapeutic penetrating keratoplasty was performed when the infection and its accompanying inflammation became clinically unresponsive to multifold therapy, and a corneal perforation was imminent. The eye was salvaged with a resulting clear graft and stable intraocular pressures.