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 Table of Contents  
PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 794-795

Dematiaceous fungi colonizing the bandage contact lens - An unusual presentation


1 Consultant Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Cuddalore Main Road, Thavalukuppam, Pondicherry, India
2 Consultant Pediatric and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Cuddalore Main Road, Thavalukuppam, Pondicherry, India
3 Department of Microbiology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Cuddalore Main Road, Thavalukuppam, Pondicherry, India

Date of Submission27-Apr-2021
Date of Acceptance10-May-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. Bharat Gurnani
Consultant Cataract, Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry 605 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1012_21

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  Abstract 


Keywords: Bandage contact lens, dematiaceous, fungi


How to cite this article:
Gurnani B, Vedachalam R, Narayana S, Kaur K, Gubert J. Dematiaceous fungi colonizing the bandage contact lens - An unusual presentation. Indian J Ophthalmol Case Rep 2021;1:794-5

How to cite this URL:
Gurnani B, Vedachalam R, Narayana S, Kaur K, Gubert J. Dematiaceous fungi colonizing the bandage contact lens - An unusual presentation. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 18];1:794-5. Available from: https://www.ijoreports.in/text.asp?2021/1/4/794/327619



A 60-year-old female with pseudophakic bullous keratopathy presented with pain and defective vision in OD for 3 months. She also gave a history of cataract surgery performed in OD 3 years back. Slit-lamp anterior segment examination revealed conjunctival congestion, epithelial bullae, diffuse stromal edema with corneal decompensation, and the rest of the details were hazy. Fundoscopy was hazy in OD. Anterior and posterior segment examination in left eye (OS) was normal. Her visual acuity was finger counting close to the face (FCF) OD and 20/20 in OS. Intraocular pressure by noncontact tonometry was an error in OD and 14 mmHg OS. In view of severe pain, bullae rupture was done and a Bandage contact lens (BCL) was applied. She was advised topical 0.5% moxifloxacin six times/day, 0.5% carboxymethyl cellulose six times/day and 1% homatropine two times/day eye drop under close follow-up. The patient was lost to follow-up for 2 months. Later she presented with pigmented mid-stromal fungal infiltrate of 4 mm × 4 mm with another 3 mm × 3 mm central pigmented patch under the BCL [Figure 1]a. Scraping was performed which revealed pigmented fungal hyphae on 10% KOH and culture on potato dextrose agar and lactophenol cotton blue mount revealed Alternaria spp. Pigmented fungal infiltrate under BCL [Figure 1]b is a very rare occurrence. After the culture results, the patient was treated with topical 5% natamycin and 1% itraconazole hourly, 0.5% moxifloxacin six times, 1% homatropine two times, and advised follow-up after 5 days.
Figure 1: (a) Image of the right eye of the patient depicting pigmented fungus in the BCL (b) Image of BCL with pigmented fungus held with toothed forceps in the Microbiology lab (c) Image of the right eye of the same patient depicting 4 mm × 4 mm mid-stromal infiltrate post-BCL removal (d) Image of the 10% KOH mount depicting narrow septate hyphae confirming pigmented fungus (X40) (e) Image depicting colony morphology of Alternaria spp. growth on culture plate of potato dextrose agar (X40) (f) Image depicting Alternaria spp. hyphae with elliptical conidia on lactophenol cotton blue mount (X40)

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  Discussion Top


The fungal entry in the lens matrix is promoted by manufacturing defects of the lens, structural damage, repetitive removal, and application of the lens.[1] This is a very rare presentation of dematiaceous fungi Alternaria in BCL. This case highlights the importance of contact lens care and handling, patient education, counseling, and regular follow-up post-BCL application.[2],[3] Prompt microbiological evaluation and meticulous management can prevent irreversible blinding sequelae in these scenarios.

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.

Acknowledgments

Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lalitha CS, Nayak B, Hallur V, Kharolia A. Invasion of the therapeutic contact lens by a rare fungal species presenting as the acute red eye: A case report. Indian J Ophthalmol Case Rep2020;68:2548-50.  Back to cited text no. 1
    
2.
Dutta A, Das S, Behera HS, Mittal R. Dematiaceous fungal invasion of a bandage contact lens. BMJ Case Rep 2021;14:e240029.  Back to cited text no. 2
    
3.
Srirampur A, Mansoori T, Kola P, Kalwad A, Reddy AK. Dematiaceous fungal colonization of the bandage contact lens in a patient lost to follow-up during the COVID-19 crisis. Eye Contact Lens 2020;46:e66-8.  Back to cited text no. 3
    


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