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product. Several theories have been proposed to explain the sudden increased incidence of Fusarium keratitis in contact lens wearers, and these were discussed at the 2006 American Academy of Ophthalmology annual meeting. These theories included the possible loss of antimicrobial activity during contact lens storage, and the selective growth of Fusarium in globules of partially dried deposits of ReNu with MoistureLoc. In addition, because the contact lens solutions on the market are composed of different disinfectants and antimicrobial agents, it is possible that there is a generalized decreased effectiveness of all-in-1 solutions to kill Fusarium compared with previous disinfecting systems. It is also possible that Fusarium has a propensity to bind to different contact lens materials. Further research is needed, especially into theories involving other possible contact lens solutions besides ReNu with MoistureLoc, so that this outbreak can be better understood and controlled. In summary, it appears that the Fusarium keratitis outbreak may not be finished, and that this condition may be associated with other contact lens cleaning solutions. Ophthalmologists should be aware of this and must therefore continue to be vigilant in suspecting this infection. Any suspicious infiltrate should be scraped for culture, and prompt appropriate antifungal therapy should be instituted. Correspondence: Dr Jeng, The Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave, Building i-32, Cleveland, OH 44195 (jengb@ccf.org). Financial Disclosure: None reported. Funding/Support: Supported in part by a Research to Prevent Blindness Challenge Grant (Drs Jeng and Meisler). Previous Presentation: Presented in part at the Federated Societies Scientific Session; November 10, 2006; Las Vegas, Nevada.

Eyelid Melanoma With Negative Sentinel Lymph Node Biopsy and Perineural Spread