Bilateral toxic epithelial keratopathy following instillation of expired topical eye drops

Toxic corneal epitheliopathies are common, but the majority are probably so mild that they are subclinical. Clinically significant epithelial keratopathy can occur following a single drop of topical expired carboxymethylcellulose sodium eye drops.

This case presents A 34-year-old female who presented to the emergency department with a history of severe ocular pain and reduced vision after bilateral instillation of expired eye drops. Both eyes were diagnosed with toxic epithelial keratopathy. The presenting best corrected visual acuity (BCVA) was 20/100 in the right eye and 20/300 in the left eye. The BCVA at last follow-up was 20/20 in both eyes.

The safe use and storage of ophthalmic drugs, including their use before the expiration date, should be reinforced to patients by all healthcare practitioners to avoid complications such as toxic keratopathy.