An unusual presentation of orbital cellulitis: RGP contact lens retained for 14 years with erosion into the orbit

Abstract

A 31-year-old man was referred to the Department of Ophthalmology and Visual Sciences, University of Maryland, with a 4-day history of worsening left eye pain, redness, discharge, and limitation of upgaze (A). Computed tomography of the orbit revealed a 12.1 × 6.6 mm circumscribed “fluid” collection above the left superior rectus muscle (B). Imaging did not reveal any discernable nidus for abscess formation, such as adjacent sinus disease or obvious foreign body. Given the patient’s worsening course and suspected orbital abscess, he underwent surgical drainage. Intraoperatively, the upper lid was everted exposing purulent material in the superior cul-de-sac. The globe was rotated inferiorly to expose the upper fornix, revealing an area of complete conjunctival erosion with a circular translucent foreign body resting on the superior surface of the superior rectus (C). The object was easily extracted and identified as an RGP lens. The patient recovered fully, with no residual deficits. Postoperatively, it was discovered that the patient’s last contact lens use was over 14 years prior. On reexamination of the patient’s imaging after surgery, a crescent-shaped hypodensity anterior to the fluid collection was noted, possibly the retained lens. Magnetic resonance imaging and computed tomography can be useful for identifying retained contact lenses; however, these modalities are often low yield. Diagnosis of retained contact lenses may be exceedingly difficult in the absence of suspicion.