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Pseudomonas aeruginosa Corneal Infection Related to Mascara Applicator Trauma -- Georgia

On January 11, 1989, a 47-year-old woman in Georgia scratched her left eye with a mascara applicator and subsequently had onset of progressive pain, light sensitivity, redness, and swelling of the eye. Examination by a physician on January 12 revealed a corneal abrasion; gentamicin ointment was instilled, and the eye was patched. Three days after onset, ophthalmologic consultation documented severely impaired vision and a corneal abscess in the patient's left eye, and the patient was admitted for treatment. Gram stain of corneal scrapings revealed gram-negative rods. Culture of the corneal scrapings and of a sample of the patient's mascara grew Pseudomonas aeruginosa with identical antibiotic susceptibility patterns.

Following inpatient therapy, including subconjunctival gentamicin, the infection resolved; however, on discharge from the hospital, a dense inflammatory corneal infiltrate was present. Subsequently, diffuse neovascularization of the cornea developed; vision in the patient's eye has not improved. Reported by: LA Wilson, MD, Emory Univ, Atlanta; RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human Resources. Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Only nine cases of P. aeruginosa eye infections associated with mascara applicator trauma and mascara contamination have been reported (1-3). New mascara is rarely contaminated with bacteria but can become contaminated with P. aeruginosa and other bacteria after use (4,5).

The case described here demonstrates the rapidity with which P. aeruginosa infection can progress and the severity of residual damage. Ophthalmologists and other health-care workers who evaluate patients with eye complaints should be aware of mascara applicator trauma as a potential risk factor for infection. Prompt ophthalmologic consultation should be obtained for suspected P. aeruginosa corneal infections.

Further efforts are needed to delineate the epidemiology of Pseudomonas corneal infections related to mascara contamination. When the medical history suggests that antecedent mascara application may be associated with corneal infection, health-care workers should consider culturing the mascara of affected patients. Suspected cases should be reported through state health departments to the Meningitis and Special Pathogens Branch, Division of Bacterial Diseases, Center for Infectious Diseases, CDC, Mailstop C09, Atlanta, GA 30333; telephone (404) 639-3687.

References

  1. Wilson LA, Ahern DG. Pseudomonas-induced corneal ulcer associated with contaminated eye mascaras. Am J Ophthalmol 1977;84:112-9.

  2. Thomas ET, Barton SN. The role of eye cosmetic contaminants in the pathogenesis of eye infection: an epidemiologic investigation. Ala J Med Sci 1978;15:246-51.

  3. Reid FR, Wood TO. Pseudomonas corneal ulcer. Arch Ophthalmol 1979;97:1640-1.

  4. Wilson LA, Kuehne JW, Hall SW, et al. Microbial contamination in ocular cosmetics. Am J Ophthalmol 1971;71:1298-302.

  5. Ahern DG, Wilson LA, Julian AJ, et al. Microbial growth in eye cosmetics: contamination during use. Dev Ind Microbiol 1974;15:211-6.



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