Superior fornix mass with retained soft contact lens

Carl Benjamin Rebhun; Ann Q Tran; Irina Belinsky

doi:10.4103/ijo.IJO_1819_20

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Year : 2021 | Volume : 1 | Issue : 1 | Page : 34

Superior fornix mass with retained soft contact lens

Carl Benjamin Rebhun, Ann Q Tran, Irina Belinsky
Department of Ophthalmology, NYU Langone Health, New York, USA

Date of Submission	08-Jun-2020
Date of Acceptance	24-Jul-2020
Date of Web Publication	31-Dec-2020

Correspondence Address:
Dr. Irina Belinsky
NYU Langone Health, New York
USA

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1819_20

Abstract

Keywords: Contact lens, foreign body granuloma, oculoplastics

How to cite this article:
Rebhun CB, Tran AQ, Belinsky I. Superior fornix mass with retained soft contact lens. Indian J Ophthalmol Case Rep 2021;1:34

How to cite this URL:
Rebhun CB, Tran AQ, Belinsky I. Superior fornix mass with retained soft contact lens. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Mar 3];1:34. Available from: https://www.ijoreports.in/text.asp?2021/1/1/34/305511

A 35-year-old female presented to the oculoplastics clinic for a 1-month history of left upper eyelid painful mass, ptosis, and superior conjunctivitis with discharge [Figure 1]a. A palpable, pyogenic-like mass was present in the deep superior fornix. Computed tomography imaging demonstrated a 1.2 cm well-circumscribed lesion superficially in the upper eyelid [Figure 1]b. Intraoperatively, double eversion of the eyelid and dissection into the mass revealed a large pocket granuloma with a retained soft contact lens [Figure 1]c.

Figure 1: A case of a retained contact lens causing foreign body granuloma. (a) External photograph demonstrating left eyelid fullness, ptosis, and conjunctival injection. (b) Computed tomography sagittal cut demonstrating a well-circumscribed, centrally low-density cystic lesion (yellow arrow) in the anterosuperior margin of the left globe. (c) Intraoperative photograph demonstrating everted superior eyelid with a deep forniceal defect containing a foreign body granuloma and removal of soft contact lens

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Discussion

Forniceal pyogenic granulomas involving contact lenses are usually a result of rigid gas permeable lenses, and generally cause chronic conjunctivitis and eye irritation.^[1] Less commonly, retained soft contact lenses have been reported to masquerade as a superior orbital mass.^[2] In these cases, double eversion of the eyelid generally reveals a visible contact lens in the deep superior fornix. In our case, double eversion revealed a deep forniceal defect with the contact lens surrounded by granulomatous tissue. Computed tomography imaging of masses with retained contact lens generally reveals a homogeneous cyst-like mass without evidence of a foreign body.^[3] Some authors hypothesized that after a contact lens is displaced into the upper fornix, the contact lens can become fixed against the upper border of the tarsus.^[4] With blinking, the contact lens erodes through the conjunctiva and can eventually be surrounded by granulation tissue.^[5]

Regardless of a history of a lost contact lens, the presence of a soft, mobile, purulent mass in the deep fornix of a contact lens wearer should raise suspicion for a foreign body granuloma from a retained contact lens. High clinical suspicion is key to establishing this relatively rare diagnosis given that some cases may present without conjunctival irritation or injection.^[5] Surgical removal of the foreign body granuloma with a course of topical antibiotics can result in good clinical outcomes. Prevention of contact lens related complication through patient education cannot be overemphasized.

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.

References

1.	Arshad JI, Saud A, White DE, Afshari NA, Sayegh RR. Chronic conjunctivitis from a retained contact lens. Eye Contact Lens 2020;46:e1-4.
2.	Agarwal PK, Ahmed TY, Diaper CJ. Retained soft contact lens masquerading as a chalazion: A case report. Indian J Ophthalmol 2013;61:80-1. [PUBMED] [Full text]
3.	Friedberg ML, Abedi S. Encysted hard contact lens appearing as an orbital mass. Ophthalmic Plast Reconstr Surg 1989;5:291-3.
4.	Bock RH. The upper fornix trap. Br J Ophthalmol 1971;55:784.
5.	Shams P, Beckingsale A, Sheldrick J, Rose G. An unusual eyelid lump: Unsuspected embedded contact lens for up to 40 years. Two cases and literature review. Eye 2011;25:1371-3.