Bilateral topical anaesthetic abuse keratopathy

A woman in her late 30s presented with severe pain, photophobia and redness in both eyes (BE) for 3 weeks. She was diagnosed and on treatment elsewhere for presumed bilateral herpes simplex virus (HSV) keratitis, with oral antivirals and topical steroids for 4 months. Examination showed bilateral near-total corneal epithelial defects with hypertrophic edges and diffuse stromal oedema. Detailed history uncovered frequent use of topical proparacaine hydrochloride solution (0.5%) for severe pain. She underwent bilateral amniotic membrane transplantation (AMT) with tarsorrhaphy, resulting in rapid epithelialisation of the corneal surface and a gradual decrease in inflammation. She underwent sequential penetrating keratoplasty (PK) for visual restoration after the inflammation subsided completely. Our case highlights the deleterious effects of topical anaesthetic when used frequently. The clinical picture can often be confused with infectious keratitis. As noted in our case, patients commonly withhold a history of its use, which leads to diagnostic delay and vision-threatening complications.