Fungal keratitis and contact lenses: an old enemy unrecognized or a new nemesis on the block?

Purpose: To review studies of fungal keratitis related to contact lenses and determine whether the recent insurgence is a new phenomenon or an exacerbation of an ongoing trend.
Methods: A review of the recent literature on contact lens-related fungal ulcers and a comparison to older studies.
Results: The incidence of fungal keratitis associated with contact lenses increased from 5% in the 1980s to between 10% and 25% in the 1990s and was noted to be 44% in Florida at the turn of the century. The most recent study from Florida showed that the incidence had increased from 29% in the late 1990s to 52% in the early 2000s, even before the Fusarium keratitis epidemic in 2004 and 2005. This increase mainly represented an increase in the number related to nontherapeutic contact lenses.
Conclusions: Contact lens-related fungal keratitis was relatively rare 20 years ago. However, the incidence has progressively increased since then. Contact lens-related fungal ulcers had become more common even before the recent Fusarium keratitis epidemic. This change may be related to changing contact lens care habits and younger patients being fitted with contact lenses.