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Severe toxic keratopathy secondary to topical anesthetic abuse
G Rocha1, I Brunette, M Le François
1Department of ophthalmology, McGill University, Montreal, Que.
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.