Topical anesthetic abuse after radial keratotomy

A 49-year-old woman developed corneal epithelial defects and stromal infiltration shortly after a 4-cut radial keratotomy (RK) for myopia. Although cultures grew staphylococci and appropriate antibiotic treatment was applied, the epithelial defects increased in size. The corneal epithelium did not heal fully for more than 2 months. Penetrating keratoplasty 1 year later was followed by epithelial breakdown and perforation, as was a second keratoplasty. Despite repeated questioning, the patient did not admit until 18 months after her initial surgery that she had begun self-treatment with dilute proparacaine shortly after RK and continued it after her keratoplasties. The elective use of topical anesthetics to control pain after refractive surgery should be approached with caution, and patients should be warned of the possible consequences of their misuse.