Topical anesthetic abuse keratopathy: an overlooked occupational eye health concern

Topical anesthetic abuse keratopathy is a rare but potentially devastating complication that may lead to irreversible vision loss. In occupational settings, workers who sustain frequent ocular injuries may self-administer topical anesthetics without prior prescription, consequently increasing the risk of severe complications. This study evaluated the clinical findings and visual outcomes of patients with this condition.

All patients diagnosed with topical anesthetic abuse keratopathy who presented to Khalili Hospital, Shiraz, Iran, from March 2023 to March 2025 were included. Demographics, duration of abuse, risk factors, microbial culture results, treatments, and corrected distance visual acuity (CDVA) at admission and three-month follow-up were analyzed.

Thirteen patients (14 eyes; mean age, 43.15 years; 12 males, 1 female) were included. The median duration of abuse was 8.5 days (IQR = 2). Occupational exposures were the primary risk factors, including welding (5/13, 38.5%), metal grinding (3/13, 23.1%), construction work (2/13, 15.4%), and plumbing (2/13, 15.4%). Additionally, one case (1/13, 7.7%) had a history of drug abuse. Cultures were negative in 7 cases (53.8%); positive results included Staphylococcus aureus (3/13, 23.1%), Staphylococcus epidermidis (3/13, 23.1%), and Streptococcus pneumoniae (1/13, 7.7%). Following topical anesthetic cessation, all patients received supportive therapy with lubricants and broad-spectrum antibiotics. Four patients (30.8%) required hospitalization, and one (7.7%) with a history of drug abuse developed corneal perforation. The proportion of eyes with Snellen visual acuity ≥ 5/10 increased from 2/14 at baseline to 12/14 at follow-up. Median CDVA improved significantly from 0.61 (IQR 0.50) to 0.154 (IQR 0.125) LogMAR at 3 months (p < 0.001).

Topical anesthetic abuse keratopathy is a serious public health concern with potential complications such as infectious keratitis and corneal perforation. Public education, workplace protection, and stricter regulations are essential to reducing the burden of this vision-threatening disorder.

Not applicable.