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
Wilson LA, Ahern DG. Pseudomonas-induced corneal ulcer
associated with contaminated eye mascaras. Am J Ophthalmol
1977;84:112-9.
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.
Reid FR, Wood TO. Pseudomonas corneal ulcer. Arch Ophthalmol
1979;97:1640-1.
Wilson LA, Kuehne JW, Hall SW, et al. Microbial contamination
in ocular cosmetics. Am J Ophthalmol 1971;71:1298-302.
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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