J. Soc. Cosmet. Chem., 26, 169-172 (March 1975) Occurrence of Pseudomonas Aeruginosa and Staphylococcus Aureus in the Orbital Area JOHN F. McCONVILLE, B.S., and DAVID W. ANDERSON, Jr., Ph.D.* Synopsis-PSEUDOMONAS AERUGINOSA and STAPHYLOCOCCUS AUREUS were recovered in large numbers from the ORBITAL AREA of two female subjects. Further investigation of these two subjects revealed that the source of these microorganisms appeared to be an INFECTION of the EXTERNAL AUDITORY CANAL. Medical diagnosis confirmed the existence of chronic ear infection in both subjects caused by P. aeruginosa in one case and S. aureus in the other. INTRODUCTION An investigation of the flora of the face and orbital area of selected subjects in Los Angeles, Calif. (1) showed large numbers of pathogens to be present in the orbital area of two subjects. Further study of these two subjects is re- ported here. Wilson et al. (2), in a study on m:crobial contamination of eye cosmetics, pointed out that pathogens and other microorganisms are a potential hazard to the injured eye. The case histories described here indicate that infections of the ear may be a source of pathogens for the orbital area. MATERIAL AND METHODS The external eye areas of 26 subjects were swabbed to determine the mi- crobial flora by the method previously reported by McConville and Anderson ( 1 ). Two subjects were found to have large numbers of S. aureus and P. aeru- ginosa, respectively, around the orbital area. To determine the extent to which these organisms had populated the facial area, both subjects were swabbed weekly around the eyes, on the cheeks and forehead, and in and around the ears for a period of several months. * Max Factor & Co., 1655 N. McCadden Place, Hollywoocl, Calif. 90028. 169

170 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS R•SI.•"LTS Subject 20 was female, age 31, and used heavy application of eye and face make-up regularly. Swabs of her eye area yielded approximately 6 x 105 mi- croorganisms per in 2. The great maiority of these bacteria were mannitol- fermenting, coagulase-positive, DNase-positive Staphylococcus. Questioning of this subject revealed chronic untreated ear problems. She complained of itching and discharge from both ears. Swabs taken of the external auditory canal gave confluent growth when streaked on Trypticase Soy Agar (TSA) (BBL). Subsequent gram stains and differential tests showed the organisms to be coagulase-positive Staphylococcus aureus. Swabs of the subject's cosmetics recovered coagulase-positive S. aureus when tested immediately after use. But when the cosmetics were retested af- ter 48 hours, no recovery of the bacteria was found. The subject was treated for Staphylococcal infection of the middle ear by a physician. After one month of treatments the infection disappeared. Swabs of her facial area then showed S. epidermidis, Micrococcus, and Bacillus species. S. aureus was not recovered from either her ears or her face. Subject 22 was female, age 29, who used eye and face make-up regularly with moderate application. Swabs of her upper and lower eyelids yielded ap- proximately 2 x 104 organisms per in 2. Gram stains showed a mixed flora of gram-positive cocci and gram-negative rods. The gram-negative rods were the predominant organisms. Subsequent isolation and identification showed the gram-positive cocci to be Staphylococcus epidermidis and the gram-negative rods to be a mixture of fluorescent and nonfluorescent strains of Pseudomonas aeruginosa. Further swabbing showed that the pseudomonads could be re- covered from her cheeks and external auditory canal. This subject also reported an untrea,ted ear problem. She had been experi- encing itching and occasional discharge from both ears for several years. Swabs of the external auditory canal yielded confluent growth of P. aerugi- nosa when streaked on TSA. Swabs of the subject's cosmetics were negative when streaked on TSA. The subject underwent medical treatment and the condition appeared to improve. P. aeruginosa was no •1onger recovered from her face or ears after repeated swabbings. Approximately 6 weeks later, the subiect again reported itching and dis- charge from her right ear. Swabs of the external auditory canal gave confluent growth of P. aeruginosa when streaked on TSA. Swabs of her facial area did not reveal the presence of this organism. Further treatment by a physician al- leviated the condition. However, 5 weeks after discontinuing medication, the symptoms reappeared. The infection has persisted for 15 months with only intermittent relief dur- ing and shortly after the application of otic medication. The extent to which the infection recurs depends upon the time elapsed between treatments.