ABSTRACT
PURPOSE: The aim of this study was to determine the impact of Acanthamoeba keratitis (AK) caused by contact lens (CL) use on vision-related quality of life (VRQOL) and the sociodemographic factors and disease outcome associated with VRQOL. METHODS: Sixty-one CL-associated AK cases and 59 asymptomatic CL wearers (mean age ±SD 39.4 ± 16.5 vs. 45.5 ± 15.2 yrs, P = 0.04) were recruited from Moorfields Eye Hospital and Institute for Optometry, London. AK cases were surveyed during active disease and were stratified into "poor" and "good" outcomes based on clinical features. VRQOL was measured using Rasch-transformed scores from the Emotional, Mobility, and Reading domains of the 32-item Impact of Visual Impairment questionnaire. AK cases were compared with controls and "poor" outcomes compared with "good" with multivariable linear regression. Multivariable linear regression models were also used to identify the sociodemographic factors and disease outcome associated with VRQOL. RESULTS: AK was associated with significant and substantial reductions in all 3 evaluated domains of VRQOL (Reading -59.6%, Mobility -59.8%, and Emotional -66.2%) compared with controls, independent of sociodemographic factors. Patients with AK who experienced poor outcomes, those who were of British White race (compared with all other races) and female, had lower VRQOL scores across all domains. Patients with AK with lower incomes scored worse on Reading and Mobility domains, whereas those with lower education had poorer Emotional scores. CONCLUSIONS: AK has a considerable detrimental impact on VRQOL. Clinicians should consider the importance of referring patients with AK for rehabilitative support and counseling as part of active disease management.
Subject(s)
Acanthamoeba Keratitis/psychology , Acanthamoeba/isolation & purification , Contact Lenses/adverse effects , Eye Infections, Parasitic/psychology , Quality of Life , Visual Acuity , Acanthamoeba Keratitis/parasitology , Acanthamoeba Keratitis/physiopathology , Adult , Case-Control Studies , Contact Lenses/parasitology , Cornea/parasitology , Eye Infections, Parasitic/parasitology , Eye Infections, Parasitic/physiopathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk FactorsABSTRACT
The authors describe preseptal cellulitis and corneal ulceration due to secondary infection of self- inflicted wounds in a patient with delusions of parasitosis. A 42-year-old man presented with a 3-day history of progressive painful, purulent, periocular erythema. He reported that "little black bugs and whitish eggs" had infiltrated his body including the left eye and eyelids. On examination, he was agitated with superficial wounds covering the majority of his body. Ophthalmic evaluation was notable for markedly erythematous and mildly edematous eyelids resulting in complete blepharoptosis. Excoriations with yellow-brown serous crusting carpeted the periocular region. A 1-mm pericentral corneal ulcer was also noted. No objective evidence of parasites was found and his infection resolved with antibacterial therapy (intravenous ceftriaxone and vancomycin, and topical vancomycin and ceftazidime). Delusions of parasitosis may result in self-mutilation with secondary infection. Appropriate psychiatric care is needed to prevent ongoing destructive behavior.
Subject(s)
Corneal Ulcer/etiology , Delusions/psychology , Ectoparasitic Infestations/psychology , Eye Infections, Parasitic/psychology , Eyelid Diseases/psychology , Orbital Cellulitis/etiology , Self Mutilation/psychology , Adult , Anti-Bacterial Agents/therapeutic use , Corneal Ulcer/drug therapy , Delusions/parasitology , Drug Therapy, Combination , Ectoparasitic Infestations/parasitology , Eye Infections, Parasitic/parasitology , Eyelid Diseases/parasitology , Humans , Male , Orbital Cellulitis/drug therapyABSTRACT
PURPOSE: To describe four cases of delusions of parasitosis in which self-inflicted ocular trauma occurred. Delusions of parasitosis is a somatic delusional disorder in which patients have the irrational belief that their bodies are infested by parasites or other infectious organisms. Self-inflicted trauma can result from attempts to eliminate the supposed infestation. METHODS: We reviewed the case histories of four patients (one male, three females, 35 to 45 years of age) who presented with complaints of ocular infestation but had no evidence of infectious ocular disease. The characteristics of these cases were compared with the features of delusions of parasitosis. RESULTS: All patients maintained their beliefs regarding infestation, despite extensive clinical and laboratory investigations that found no evidence of infectious diseases. Self-inflicted eye injury, associated with attempts to eliminate the infestation, occurred in each case. CONCLUSIONS: The cases presented in this report are consistent with a diagnosis of delusions of parasitosis. The eye can be a principal focus of attention in this disorder, which may lead to vision loss caused by self-inflicted injury.
