“The eye that survived”: A case of isolated fungal colonization of bandage contact lens without corneal involvement

A 35-year-old female patient with a past history of open globe injury in her right eye with corneal perforation repair done 6 months back presented to us with complaints of watering and foreign body sensation of 2 weeks duration in that eye. The visual acuity in the right eye was perception of light positive with accurate projection of rays in all quadrants. On slit-lamp evaluation, diffuse conjunctival congestion with multiple black-colored mass lesions on the surface of cornea reaching up to limbus was noted Fig. 1a. There was a noticeable absence of scleritis which was naturally expected with such dense corneal infiltration. This doubt led to a much closer observation, and then, we could identify the edge of a bandage contact lens (BCL) on inferior gaze. The BCL was subsequently removed under slit lamp Fig. 1c, and the underlying cornea showed no signs of keratitis Fig. 1b. The anterior chamber was quiet, and USG B-scan of the right eye showed retinal detachment. The left eye was within normal limits.Figure 1: (a) Slit-lamp image of the right eye showing diffuse circumcorneal congestion with multiple black-colored mass lesions on the surface of the cornea extending up to the limbus. (b) Slit-lamp image after BCL removal showing a corneal scar with intact 10-0 monofilament nylon sutures of perforation repair and inferonasal vascularization of the cornea. (c) Removed bandage contact lens with pigmented growth on surface. (d) Culture of the removed BCL on Sabouraud’s dextrose agar media showing growth of dematiaceous fungi. (e) Lacto-phenol cotton blue mount microscopic image showing pigmented septate hyphae with sympodial geniculate arrangements of conidia with three septations and swollen central cells of conidia suggestive of Curvularia lunataThe patient was prophylactically started on 5% Natamycin eye suspension 4 times a day. On culture, the removed BCL on Sabouraud’s dextrose agar media showed growth of dematiaceous fungi Fig. 1d, which were identified as Curvularia spp on microscopic examination Fig. 1e. Discussion BCLs are widely used in ophthalmic practice to manage corneal surface disorders. Extended use of BCLs,1–3 poor compliance with doctor’s advice,4 inadvertent use of steroid drops, and irregular follow-up visits are factors that significantly increase the risk for contact lens-related infectious keratitis. Our case is unique with the identification of Curvularia species on microbiological evaluation and also in the absence of any evidence of associated curvularia keratitis. Authors’ contributions Dr. Salu Chandran – literature search, data acquisition, manuscript preparation; Dr. Nimmy Raj - data acquisition, manuscript editing; Dr. Manumuraleekrishna - manuscript editing, manuscript review; Dr. M. Vanathi – concept, design, manuscript review; Dr. Nishat Hussain Ahmed – strain identification, manuscript review Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.