A lost contact lens with retention of the whole or a fragment of the lens is a common ocular emergency. Usually, the lost lens can be retrieved easily, but occasionally it may remain undetected and migrate through superficial tissue to remain buried. The patient may present with symptoms such as red eye, chronic irritation or ptosis but it may remain dormant within deeper tissue without any symptoms or signs. Cases have been reported in the past of hard contact lens in the superior fornix and eyelid.
We report a case of a misplaced, soft contact lens masquerading as a chalazion 13 years later. To the best of our knowledge, no previous case has been described in the literature of lost soft contact lens so many years after the initial insult.
An 83-year-old female with a left upper lid swelling was referred by her physician. She reported having this gradually enlarging, painless swelling for the last 2–3 years, which was now causing her eyelid to droop. She had been a soft contact lens wearer for 14 years. There was no history of any ocular trauma or lid surgery. On examination, a freely mobile 2 cm × 3 cm cystic swelling was noted in the left upper lid, which was causing an upper lid ptosis of 1 mm [Fig. 1a]. The rest of the ocular examination was normal. A presumptive diagnosis of chalazion was made and an incision and curettage was performed. During the procedure, a soft silicone hydrogel contact lens with granulation tissue was noted at the base of the cystic lesion and removed [Fig. 1b]. On further questioning, it transpired that 13 years previously she had lost a soft contact lens from her left eye. She assumed that it has spontaneously fallen out and she never went to see an optician or an ophthalmologist. Following this incident, she resumed uneventful contact lens wear.
Contact lens wearers very commonly lose a lens. On occasion, it may be assumed that it has fallen out spontaneously when in fact the whole lens or a torn fragment has been retained. Usually, these follow symptoms of irritation resulting in the lens being recovered, but occasionally it can be retained for many years without any symptoms as has been reported previously with hard contact lenses. Perhaps, a soft contact lens has more chance of remaining in the fornices without any symptom due to the nature of the material. This case highlights how a retained conjunctival foreign body, such as a soft contact lens, can migrate through the palpebral conjunctiva and levator aponeurosis to a new location just anterior to the tarsal plate. [Fig. 2]
The chronic trauma and irritation caused by the misplaced lens may be asymptomatic from the patient's perspective; this is probably due to the soft and hydrophilic nature of the contact lens material. Benger et al. postulated that the sequestered nature of conjunctival epithelium may be responsible for minimal tissue reaction to soft contact lenses. As suggested by Freidberg et al, a retained hard contact lens presenting as lid swelling is not uncommon, but to our knowledge, migration of a soft contact lens in this way has not been reported previously. This case highlights the importance of a thorough ocular examination including double eversion of the upper lid and sweeping of the fornices with cotton bud in a patient with lost or mislocated contact lenses, and is possibly more important in soft than hard contact lenses.
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Source of Support: Nil.
Conflict of Interest: None declared.