Severe toxic keratopathy secondary to topical anesthetic abuse.

Abstract

OBJECTIVE: To describe the clinical findings in three cases of abuse of topically administered ophthalmic anesthetics and to review the clinical signs, diagnosis and treatment. DESIGN: Case series. SETTING: Two university-affiliated hospitals in Montreal. PATIENTS: Three patients with toxic keratopathy due to abuse of topically applied anesthetics. RESULTS: The three patients presented with a nonhealing epithelial defect, marked stromal edema, folds in Descemet's membrane and a typical stromal ring infiltrate. All three required a conjunctival flap, and two underwent penetrating keratoplasty. The drugs (0.5% tetracaine and 0.5% proparacaine) were easily obtained, at the workplace in two cases and by stealing from the ophthalmologist's examining room in the third case. CONCLUSIONS: The unrestricted availability of topically applied ophthalmic anesthetics as over-the-counter medications in Canada must be reevaluated.