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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.
      • Schaefer F.
      • Bruttin O.
      • Zografos L.
      • Guex-Crosier Y.
      Bacterial keratitis: a prospective clinical and microbiological study.
      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.
      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 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).
      Figure thumbnail gr2
      Fig. 2Healing corneal ulcer caused by lash extension.
      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.
      • Amano Y.
      • Sugimoto Y.
      • Sugita M.
      Ocular disorders due to eyelash extensions.
      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 eyelid-fixing 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.
      Hemophilus influenza has been described as a causative organism in contact lens–related inflammatory events and keratitis.
      • Schaefer F.
      • Bruttin O.
      • Zografos L.
      • Guex-Crosier Y.
      Bacterial keratitis: a prospective clinical and microbiological study.
      • Willcox M.
      • Sharma S.
      • Naduvilath T.J.
      • Sankaridurg P.R.
      • Gopinathan U.
      • Holden B.A.
      External ocular surface and lens microbiota in contact lens wearers with corneal infiltrates during extended wear of hydrogel lenses.
      • Leahey A.B.
      • Jones D.
      Haemophilus influenzae central corneal ulcer associated with cosmetic lens wear.
      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.
      • Yang K.S.
      • Lin H.C.
      • Ma D.H.
      • et al.
      Ulcerative keratitis caused by Haemophilus influenzae.
      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.

      References

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        Bacterial keratitis: a prospective clinical and microbiological study.
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        Ocular disorders due to eyelash extensions.
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