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Semipermanent eyelash extensions causing bacterial keratitis: a case report
Correspondence (31) of the toric IOL after its sulcus fixation. Specifically, postoperative corneal astigmatism was 7.36 641, which confirms the presence of a small induction of corneal astigmatism limiting the predictability of the IOL correction. Furthermore, Viestenz et al.7 estimated that 31 of toric IOL rotation would lead to residual astigmatism that is 10% of the initial astigmatic power. Also, the separation between the optics of both IOLs may have played a role in the astigmatic undercorrection. On the other hand, adjustments are necessary for accurate calculations of IOL power when IOLS are placed on sulcus,8,9 and especially when these IOLs are combined with an in-the-bag lens in a piggyback format. We did not know whether these adjustments were considered in the mathematical approaches used by the manufacturer’s software. Regarding CDVA, it also improved significantly from a prepiggyback implantation value of 0.7 to a postoperative value of 0.9. Postoperative aberrometric analysis revealed a reduced presence of internal coma and spherical aberration, with values compensating partially for the corneal levels of these 2 types of higher order aberrations. This suggests a potential aberrometric reduction with piggyback surgery, contributing to CDVA improvement, as well as to UDVA improvement. In addition, higher levels of ocular trefoil aberration were found in this case postoperatively that have a minor impact on visual outcomes, as expected according to the type of blur induced by this optical aberration.10 In conclusion, piggyback toric IOL implantation in sulcus is an option to consider in cases of high and even severe corneal astigmatism in which corneal surgery for cylindrical correction is not possible due to an underlying corneal pathologic condition. More research is needed to improve the accuracy of IOL power calculation in such types of implantation to avoid astigmatic undercorrections.
Semipermanent eyelash extensions causing bacterial keratitis: a case report Bacterial keratitis is a potentially sight-threatening condition, and major risk factors include contact lens wear and trauma. Keratitis is commonly caused by Pseudomonas aeruginosa, Staphylococcus, and Streptococcus species.1 Other pathogens are less common. Cultures taken from the corneal ulcer before initiation of antibiotics can establish the causative organism and allow a targeted treatment approach. We report a case of bacterial keratitis caused by Hemophilus influenza, contributed to by the presence of permanent lash extensions. To our knowledge, this is the first time that bacterial keratitis has been reported as a complication of semipermanent lash extensions.
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CAN J OPHTHALMOL — VOL. 48, NO. 3, JUNE 2013
ˇ ˇ ´k, * Peter Mojzˇiˇs, *,z Peter Ziak, *,† Miroslav Sesta y David P. Pin˜ero *
Eye Clinic of Jessenius Faculty of Medicine, Comenius University, University Hospital; †Uvea Mediklinik, Martin, Slovakia; zPremium Clinic, Teplice, Czech Republic; yUniversity of Alicante, Alicante, Spain Correspondence to: David P. Pin˜ero, PhD: [email protected]
REFERENCES 1. Van der Meulen IJ, Van Rooij J, Hazes JW, Van Cleynenbreugel H, Geerards AJ, Remeyer L. Corneal melting after ocular surgery in patients with auto-immune disorders. Ned Tijdschr Geneeskd. 2007;151:920-3. 2. Kahraman G, Amon M. New supplementary intraocular lens for refractive enhancement in pseudophakic patients. J Cataract Refract Surg. 2010;36:1090-4. 3. Jin H, Limberger IJ, Borkenstein AF, Ehmer A, Guo H, Auffarth GU. Pseudophakic eye with obliquely crossed piggyback toric intraocular lenses. J Cataract Refract Surg. 2010;36:497-502. 4. Gills JP. Sutured piggyback toric intraocular lenses to correct high astigmatism. J Cataract Refract Surg. 2003;29:402-4. 5. Gills JP, Van der Karr MA. Correcting high astigmatism with piggyback toric intraocular lens implantation. J Cataract Refract Surg. 2002;28:547-9. 6. Till JS. Piggyback silicone intraocular lenses of opposite power. J Cataract Refract Surg. 2001;27:165-8. 7. Viestenz A, Seitz B, Langenbucher A. Evaluating the eye’s rotational stability during standard photography: effect on determining the axial orientation of toric intraocular lenses. J Cataract Refract Surg. 2005;31:557-61. 8. Langwin´ska-Wos´ko E, Skopin´ski P, Ko"odziejczyk W, Szulborski K, Wo´jcik-Gryciuk A. A retrospective analysis of the intraocular lens power calculation in cases of sulcus fixation. Klin Oczna. 2011;113:13-5. 9. Suto C, Hori S, Fukuyama E, Akura J. Adjusting intraocular lens power for sulcus fixation. J Cataract Refract Surg. 2003;29:1913-7. 10. Applegate RA, Sarver EJ, Khemsara V. Are all aberrations equal? J Refract Surg. 2002;18:S556-62. Can J Ophthalmol 2013;48:e48–e50 0008-4182/13/$-see front matter & 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2012.12.007
A 29-year-old female presented with increasingly painful and photophobic left eye, associated with blurring of vision. She described ongoing eye irritation for approximately 4 weeks, before becoming painful. She was otherwise healthy, with no significant medical history. Her ophthalmic history included a previous corneal abrasion of her right eye, which had resolved without complications. She had never worn contact lenses, cosmetic or corrective. There was no recent history of trauma to either eye. The patient had received semipermanent eyelash extensions several days before onset of the left eye irritation (Fig. 1). She had previously worn these extensions without complications. On examination, best corrected visual acuity was measured to be 6/4.8 right and 6/9.5 left. On examination, the patient was notably photophobic in her left eye. The left
Correspondence eye was injected considerably, and a corneal ulcer with dense stromal infiltrate, measuring 1 2 mm, was observed in the inferotemporal cornea. When the patient was blinking, the bonding agent of an eyelash extension was in contact with the cornea at the site of the ulcer. Anterior chamber was deep with trace cells. The remainder of the examination including dilated fundoscopy was normal. Corneal scrapings were performed and the patient was empirically started on fortified antibiotic eye drops (cefazolin 5% and gentamicin 1%), administered hourly to her left eye, including overnight. Subsequently, Hemophilus influenza was cultured from the corneal scrapings. The patient continued to improve with appropriate topical treatment, and the keratitis resolved fully (Fig. 2). Semipermanent eyelash extensions appear to be increasingly popular as part of cosmetic enhancements. During the application process, single artificial lashes are glued to individual eyelashes. The resin used to bond the artificial and natural lash is permanent. Minor complications associated with eye-lash extensions have been reported in 1 recent Japanese study.2 The authors believed that the increasing popularity of semipermanent eye lash extensions had led to a rapid increase in their ophthalmological consultation rooms for ocular disorders caused by the lashes themselves or the glue used as bonding agent between the actual lash and its artificial extension lash. That study assessed 170 females aged between 21 and 52 years with no previous ocular history. The most common disorders included keratoconjunctivitis caused by the glue or its removal agents and allergic blepharitis. Other reported problems included conjunctival erosions secondary to eyelidfixing tapes and subconjunctival haemorrhage. The authors proceeded to assess 3 types of glue used to bond the lash extensions, and found all of them to contain elevated formaldehyde levels, thus concluding that the lash extensions, the bonding agents, and removal thereof can cause ocular disorders. The authors did not report any more serious complications such as keratitis described in the present case.
Fig. 2 — Healing corneal ulcer caused by lash extension.
Hemophilus influenza has been described as a causative organism in contact lens–related inflammatory events and keratitis.1,3,4 A case series assessing the clinical parameters of keratitis caused by Hemophilus influenza identified risk factors including previous surgeries, herpes simplex keratitis, leukoma adherence, and exposure keratitis.5 Despite good response to appropriate antibiotic therapy, the authors reported variable visual outcomes. To our knowledge, this is the first reported case of eyelash extensions causing bacterial keratitis. Eyelash extensions (including their bonding resin) should therefore be considered as potential risk factors for bacterial keratitis, and appropriate cultures for organisms allow treatment for less common pathogens. Katja Ullrich, Niladri Saha Flinders Medical Centre, Adelaide, South Australia, Australia Correspondence to: Katja Ullrich, BMBS, BBioMedS: [email protected]
REFERENCES 1. Schaefer F, Bruttin O, Zografos L, Guex-Crosier Y. Bacterial keratitis: a prospective clinical and microbiological study Br J Ophthalmol. 2001;85:842-7. 2. Amano Y, Sugimoto Y, Sugita M. Ocular disorders due to eyelash extensions. Cornea. 2012;31:121-5. 3. Willcox M, Sharma S, Naduvilath TJ, Sankaridurg PR, Gopinathan U, Holden BA. External ocular surface and lens microbiota in contact lens wearers with corneal infiltrates during extended wear of hydrogel lenses. Eye Contact Lens. 2011;37:90-5. 4. Leahey AB, Jones D. Haemophilus influenzae central corneal ulcer associated with cosmetic lens wear. CLAO J. 1996;22:213-4. 5. Yang KS, Lin HC, Ma DH, et al. Ulcerative keratitis caused by Haemophilus influenzae. Cornea. 2006;25:701-4.
Fig. 1 — Eyelash extensions.
Can J Ophthalmol 2013;48:e50–e51 0008-4182/13/$-see front matter Crown Copyright & 2013 Published by Elsevier Inc on behalf of the Canadian Ophthalmological Society. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2012.12.010
CAN J OPHTHALMOL — VOL. 48, NO. 3, JUNE 2013
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Semipermanent eyelash extensions causing bacterial keratitis: a case report Bacterial keratitis is a potentially sight-threatening condition, and major risk factors include contact lens wear and trauma. Keratitis is commonly caused by Pseudomonas aeruginosa, Staphylococcus, and Streptococcus species.1 Other pathogens are less common. Cultures taken from the corneal ulcer before initiation of antibiotics can establish the causative organism and allow a targeted treatment approach. We report a case of bacterial keratitis caused by Hemophilus influenza, contributed to by the presence of permanent lash extensions. To our knowledge, this is the first time that bacterial keratitis has been reported as a complication of semipermanent lash extensions.
e50
CAN J OPHTHALMOL — VOL. 48, NO. 3, JUNE 2013
ˇ ˇ ´k, * Peter Mojzˇiˇs, *,z Peter Ziak, *,† Miroslav Sesta y David P. Pin˜ero *
Eye Clinic of Jessenius Faculty of Medicine, Comenius University, University Hospital; †Uvea Mediklinik, Martin, Slovakia; zPremium Clinic, Teplice, Czech Republic; yUniversity of Alicante, Alicante, Spain Correspondence to: David P. Pin˜ero, PhD: [email protected]
REFERENCES 1. Van der Meulen IJ, Van Rooij J, Hazes JW, Van Cleynenbreugel H, Geerards AJ, Remeyer L. Corneal melting after ocular surgery in patients with auto-immune disorders. Ned Tijdschr Geneeskd. 2007;151:920-3. 2. Kahraman G, Amon M. New supplementary intraocular lens for refractive enhancement in pseudophakic patients. J Cataract Refract Surg. 2010;36:1090-4. 3. Jin H, Limberger IJ, Borkenstein AF, Ehmer A, Guo H, Auffarth GU. Pseudophakic eye with obliquely crossed piggyback toric intraocular lenses. J Cataract Refract Surg. 2010;36:497-502. 4. Gills JP. Sutured piggyback toric intraocular lenses to correct high astigmatism. J Cataract Refract Surg. 2003;29:402-4. 5. Gills JP, Van der Karr MA. Correcting high astigmatism with piggyback toric intraocular lens implantation. J Cataract Refract Surg. 2002;28:547-9. 6. Till JS. Piggyback silicone intraocular lenses of opposite power. J Cataract Refract Surg. 2001;27:165-8. 7. Viestenz A, Seitz B, Langenbucher A. Evaluating the eye’s rotational stability during standard photography: effect on determining the axial orientation of toric intraocular lenses. J Cataract Refract Surg. 2005;31:557-61. 8. Langwin´ska-Wos´ko E, Skopin´ski P, Ko"odziejczyk W, Szulborski K, Wo´jcik-Gryciuk A. A retrospective analysis of the intraocular lens power calculation in cases of sulcus fixation. Klin Oczna. 2011;113:13-5. 9. Suto C, Hori S, Fukuyama E, Akura J. Adjusting intraocular lens power for sulcus fixation. J Cataract Refract Surg. 2003;29:1913-7. 10. Applegate RA, Sarver EJ, Khemsara V. Are all aberrations equal? J Refract Surg. 2002;18:S556-62. Can J Ophthalmol 2013;48:e48–e50 0008-4182/13/$-see front matter & 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2012.12.007
A 29-year-old female presented with increasingly painful and photophobic left eye, associated with blurring of vision. She described ongoing eye irritation for approximately 4 weeks, before becoming painful. She was otherwise healthy, with no significant medical history. Her ophthalmic history included a previous corneal abrasion of her right eye, which had resolved without complications. She had never worn contact lenses, cosmetic or corrective. There was no recent history of trauma to either eye. The patient had received semipermanent eyelash extensions several days before onset of the left eye irritation (Fig. 1). She had previously worn these extensions without complications. On examination, best corrected visual acuity was measured to be 6/4.8 right and 6/9.5 left. On examination, the patient was notably photophobic in her left eye. The left
Correspondence eye was injected considerably, and a corneal ulcer with dense stromal infiltrate, measuring 1 2 mm, was observed in the inferotemporal cornea. When the patient was blinking, the bonding agent of an eyelash extension was in contact with the cornea at the site of the ulcer. Anterior chamber was deep with trace cells. The remainder of the examination including dilated fundoscopy was normal. Corneal scrapings were performed and the patient was empirically started on fortified antibiotic eye drops (cefazolin 5% and gentamicin 1%), administered hourly to her left eye, including overnight. Subsequently, Hemophilus influenza was cultured from the corneal scrapings. The patient continued to improve with appropriate topical treatment, and the keratitis resolved fully (Fig. 2). Semipermanent eyelash extensions appear to be increasingly popular as part of cosmetic enhancements. During the application process, single artificial lashes are glued to individual eyelashes. The resin used to bond the artificial and natural lash is permanent. Minor complications associated with eye-lash extensions have been reported in 1 recent Japanese study.2 The authors believed that the increasing popularity of semipermanent eye lash extensions had led to a rapid increase in their ophthalmological consultation rooms for ocular disorders caused by the lashes themselves or the glue used as bonding agent between the actual lash and its artificial extension lash. That study assessed 170 females aged between 21 and 52 years with no previous ocular history. The most common disorders included keratoconjunctivitis caused by the glue or its removal agents and allergic blepharitis. Other reported problems included conjunctival erosions secondary to eyelidfixing tapes and subconjunctival haemorrhage. The authors proceeded to assess 3 types of glue used to bond the lash extensions, and found all of them to contain elevated formaldehyde levels, thus concluding that the lash extensions, the bonding agents, and removal thereof can cause ocular disorders. The authors did not report any more serious complications such as keratitis described in the present case.
Fig. 2 — Healing corneal ulcer caused by lash extension.
Hemophilus influenza has been described as a causative organism in contact lens–related inflammatory events and keratitis.1,3,4 A case series assessing the clinical parameters of keratitis caused by Hemophilus influenza identified risk factors including previous surgeries, herpes simplex keratitis, leukoma adherence, and exposure keratitis.5 Despite good response to appropriate antibiotic therapy, the authors reported variable visual outcomes. To our knowledge, this is the first reported case of eyelash extensions causing bacterial keratitis. Eyelash extensions (including their bonding resin) should therefore be considered as potential risk factors for bacterial keratitis, and appropriate cultures for organisms allow treatment for less common pathogens. Katja Ullrich, Niladri Saha Flinders Medical Centre, Adelaide, South Australia, Australia Correspondence to: Katja Ullrich, BMBS, BBioMedS: [email protected]
REFERENCES 1. Schaefer F, Bruttin O, Zografos L, Guex-Crosier Y. Bacterial keratitis: a prospective clinical and microbiological study Br J Ophthalmol. 2001;85:842-7. 2. Amano Y, Sugimoto Y, Sugita M. Ocular disorders due to eyelash extensions. Cornea. 2012;31:121-5. 3. Willcox M, Sharma S, Naduvilath TJ, Sankaridurg PR, Gopinathan U, Holden BA. External ocular surface and lens microbiota in contact lens wearers with corneal infiltrates during extended wear of hydrogel lenses. Eye Contact Lens. 2011;37:90-5. 4. Leahey AB, Jones D. Haemophilus influenzae central corneal ulcer associated with cosmetic lens wear. CLAO J. 1996;22:213-4. 5. Yang KS, Lin HC, Ma DH, et al. Ulcerative keratitis caused by Haemophilus influenzae. Cornea. 2006;25:701-4.
Fig. 1 — Eyelash extensions.
Can J Ophthalmol 2013;48:e50–e51 0008-4182/13/$-see front matter Crown Copyright & 2013 Published by Elsevier Inc on behalf of the Canadian Ophthalmological Society. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2012.12.010
CAN J OPHTHALMOL — VOL. 48, NO. 3, JUNE 2013
e51