A routine cataract surgery for a 67-year-old woman turned unusual when medical providers found a "bluish foreign mass" that turned out to be 17 contact lens bound together—and then fished out another 10 lenses in the same eye, according to a write-up of the case in the British Medical Journal.
Rupal Morjaria—a specialist trainee ophthalmologist at Solihull Hospital in England, where the woman was treated last winter—said she and the other providers found the mass while preparing the patient for surgery. According to the case study, the mass of contacts was "bound together by mucus" in the patient's right eye. The providers used a microscope to examine the woman's eye further, which is when they found the remaining 10 lenses.
According to the case study, the patient had rarely visited an eye doctor during the 35 years she had been wearing contact lenses. At the time of treatment, the patient had said only that she needed care for cataracts—she'd made no mention of any other kind of eye irritation, and she was just as surprised at the discovery as the providers, Morjaria said.
"It was such a large mass," Morjaria continued. "We were really surprised that the patient didn't notice it because it would cause quite a lot of irritation while it was sitting there."
After removing the mass and the lingering contacts, the providers immediately delayed the patient's scheduled surgery. "Because she had harbored these contact lenses in her eye for an unknown length of time, if we had operated, she would have had a lot of bacteria" in the eye, Morjaria explained.
When asked about the situation, the woman said she had not complained about irritation in her eye because she assumed the discomfort stemmed from old age and dry eyes. The providers theorized that the contact lenses may have accumulated without notice because of the patient's "poorer vision" in her right eye, as well as because her eyes are "deep set."
At her two-week checkup after the removal, the woman said her eye "felt a lot more comfortable," Morjaria said. According to the case study, the patient did not seem to suffer any obvious infection from the amassed lenses.
Time to make an eye appointment
Morjaria said she wanted to publish the case to encourage regular eye checkups and make providers aware it's possible to lose this many contacts in an eye without major symptoms or infections—something many physicians might think impossible. "None of us have ever seen this before," Morjaria said.
Separately, Henry Leonard, a clinical and regulatory officer for the Association of Optometrists, explained, "Patients do sometimes present with a contact lens stuck under their upper eyelid, particularly if they are new to contact lens wear, or have problems with dexterity, but finding this many lenses stuck in someone's eye is exceedingly rare." He added, "Most patients would experience significant discomfort and redness, and be at risk of eye infections."
Morjaria added that checking in with an eye doctor is particularly important nowadays, when contact lenses are so readily available. "In this day and age, when it is so easy to purchase contact lenses online, people become lax about having regular check-ups," she said. "Contact lenses are used all the time, but if they are not appropriately monitored we see people with serious eye infections that can cause them to lose their sight" (Andrews, Washington Post, 7/17; de Guzman, San Francisco Chronicle, 7/17; Chappell, "The Two-Way," NPR, 7/16).
Help patients take an active role in their care
Even the best care won't result in strong outcomes unless patients are ready and willing to follow care recommendations, make necessary lifestyle changes, and play an active role in managing their own care.
That's why it's crucial that frontline clinicians have the skills to tap into patients' motivation to change. Our toolkit gives managers the resources they need to help clinicians do just that.