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The potentially blinding eye infections linked to a Bausch & Lomb Inc. contact-lens cleaner may continue even with the product off the market, doctors are reporting.

An analysis of the first outbreak of fusarium keratitis, in Singapore in March 2005, suggests the solution wasn't the sole culprit. About one-third of the patients didn't use the ReNu with MoistureLoc solution, and more than 80 percent failed to properly care for or clean their contact lenses, the study said.

Doctors and patients should be on the lookout for more infections because of other potential causes, said Donald Tan of the Singapore Eye Research Institute, senior author of the report. More studies are needed to identify other factors that put users at risk, he said.

"Fusarium keratitis in contact-lens wearers should no longer be considered a rare possibility," Tan said in an e-mail response to questions Tuesday. "While most cases were related to the MoistureLoc formulation, there have been some confirmed cases in which other contact lens solutions were used."

Doctors should have a "high index of suspicion," Tan added. Tan's report appears in today's issue of the Journal of the American Medical Association.

In all, 66 of Singapore's 224,800 contact-lens wearers were diagnosed with fusarium keratitis from March 2005 through May 2006, the researchers said. Based on a prior series of cases from 2000 through 2004, three to five cases are expected each year, they said. At least 130 Americans and 33 people in Hong Kong also developed infections.

Bausch & Lomb has launched a program aimed at educating people about the proper care of both their contact lenses and their eyes, said Meg Graham, a company spokeswoman. The report in this week's JAMA should also help raise awareness, she said.

"We believe that it serves an important educational mission in further informing the health-care community about this unusual medical phenomenon," she said in an e-mail Tuesday.

Twelve people contracted the infection in Singapore after Feb. 17, when sales of ReNu solutions were halted there, the report said. Eleven said they continued to use the cleaner even though they were aware of media advisories to stop.

"Hopefully, this experience will raise the level of awareness of the severity of fungal infections affecting the cornea, and more work can be done to find better anti-fungal treatments," Tan said.

Many people don't know the fungus is a somewhat common cause of corneal infection in underdeveloped countries and a major reason for cornea transplants in many places, including India and China, he said.