27 October 2022
Dr Katerina Kurteeva, of California Eye Associates, told OT that the patient presented on a Monday morning saying that she felt like she had something stuck in her eye. When trying to search for the source of the irritation, the patient noticed something dark in the corner of her eye.
After instilling fluorescein, Dr Kurteeva cleaned mucous away from the patient’s right eye and everted the eyelid.
“I couldn’t see anything, but I knew that the mucous could be linked to a retained foreign body,” she said.
Using a speculum to keep the eyelid open provided a wide enough angle for Kurteeva to spot a couple of contact lenses “peeking out” from underneath the patient’s right fornix.
After removing the contact lenses, Kurteeva observed the dark blob that the patient had mentioned.
“It was a very dark brown colour – almost like she had a second pupil up there,” Kurteeva said.
When she began to pull on the blob, it fragmented into a series of contact lenses.
“They were stacked like a pancake. As I was peeling them off, I was essentially creating a chain link of contact lenses,” she said.
“I had never seen so many contact lenses in a patient’s eye in my life. When they were coming out, they formed this little waterfall of contacts,” Kurteeva said.
After removing the contact lenses and thoroughly cleaning the patient’s eyes again, Kurteeva prescribed the patient anti-inflammatory steroid drops and scheduled an appointment to update the patient’s spectacle prescription.
I had never seen so many contact lenses in a patient’s eye in my life. When they were coming out, they formed this little waterfall of contacts
Kurteeva said the patient was much more comfortable after the contact lenses were removed.
“She was relieved to know what it was – she knew something was wrong, but she didn’t know what,” she observed.
“She came back after two weeks and she was doing great. Her vision is 20:20,” Kurteeva added.
Kurteeva said that the patient had been wearing contact lenses for the past 30 years but had not had an eye appointment in over two years.
She was able to receive contact lenses following a temporary loosening of the rules around supply as a result of the pandemic.
The patient was hyperopic, meaning that it was hard for her to see her contact lenses when handling them up close.
“It was deeper than usual so it was able to accommodate this large blob of foreign material,” she said.
Kurteeva added that patients are less likely to feel foreign objects located within a conjunctival pocket.
“The contacts were not on her cornea, which is the most sensitive part of the eye, all the time. She thought she was removing the contact lens off her cornea, but they were sliding into this pocket,” she shared.
Older patients may also experience reduced corneal sensation, Kurteeva noted.
Following the initial appointment on 12 September, photos and a video of the contact lens removal have since gone viral on Kurteeva’s Instagram page.
Kurteeva said that the response to the case has been unexpected.
“It was overwhelming at first, but I took it as an opportunity for public outreach. I really wanted to educate people about proper contact lens use,” Kurteeva said.
“The most devastating clinical cases are where we see sight loss as a result of infections linked to improper contact lens wear. Hopefully, this will help to prevent some infections,” she said.
Other than contact lenses, Kurteeva has removed pieces of plastic and metal from the cornea, pet hair, fabric, lashes, thorns as well as sand.
“Nail clippings are a notorious one because they can fly off and become embedded in the cornea,” she said.
Association of Optometrists clinical and regulatory adviser, Farah Topia, shared that the case highlights two important aspects of eye care.
“Firstly, that all contact lens patients should ensure they have regular check-ups with a qualified professional and secondly, why it is important that patients are provided with written advice to help remind them how they should care for their lenses. The AOP has produced patient resources for exactly this reason,” she said.
Topia emphasised that cases involving retained contact lenses are rare.
“The lens can’t go ‘behind the eye’, but can occasionally become stuck in the gap between the eye and the inside of the eyelid. Patients should remember that if they have any problems with their eyes the best thing to do is to call their local optometry practice for expert advice,” she said.
The AOP website has a range of advice for patients on proper contact lens wear, including downloadable patient leaflets.
Double take: five other unusual eye care finds
1. A man presented to an Oxford hospital in 2010 with blurred vision and pain in his eye after he mistook nail glue for eye drops. Clinicians involved in the case called for the introduction of a safety cap mechanism on superglue dispensers, noting that this was not an isolated case, and similar accidents have occurred since 1982 when superglue was repackaged in ophthalmic style dripper bottles.
2. In 2013, a Welsh woman sought treatment after a piece of glitter from a Christmas card became embedded in her cornea. Clinicians reported that the glitter has formed a clump that mimicked a dendritic ulcer.
3. In 2020, a US ophthalmic surgeon removed a BB gun pellet that had been in the patient’s eye for 68 years. The patient mailed the pellet back to his brother over half a century after the two made a pact not to tell their parents about the accident.
4. BMJ Case Reports authors described in 2019 how an encounter with a caterpillar led to unexpected ocular consequences. An 11-year-old patient with a red and watery eye was found to have multiple caterpillar cilia embedded in her cornea by Indian clinicians.
5. In 2017, a UK trainee ophthalmologist found 27 contact lenses in the eye of a patient who was scheduled for cataract surgery.
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