SUMMARY Topically applied anaesthetics may lead to a serious keratopathy. Three patients presented to us with disciform keratitis, peripheral corneal ring, and stromal infiltration following the topical use of oxybuprocaine. All three patients developed marked decrease in vision secondary to corneal scarring. In all three patients oxybuprocaine was dispensed over the counter by a pharmacist. Legislation for the restriction of over-the-counter sale of topical anaesthetics, steroids, and antibiotics is essential in the prevention of many of the self-induced ocular disorders seen in developing countries.Topical anaesthetics are commonly used by ophthalmologists for minor procedures and ocular examinations. The adverse side effects of their longterm topical use have been previously reported.'2 Fuchs' showed that intensive use of topical anaesthetics produced severe changes in the corneal epithelium and delayed recovery from corneal diseases.The indiscriminate use of topical eye drops, the lack of control of prescription drugs, and the availability of over-the-counter topical anaesthetic eye drops are common factors in the predisposition to abuse of topical anaesthetics in developing countries. We present here three cases of oxybuprocaine keratopathy.Case reports CASE 1A 42-year-old Saudi male presented with a history of pain, photophobia, and redness of the eyes for two days. He had sustained a welding arc flash injury three days earlier, and a pharmacist gave him a bottle of oxybuprocaine 04% (Novesin), which he used every half-hour without ophthalmological surveillance. On examination he was found to have a visual acuity of 20/200 in each eye. A large central epithelial defect was noted in each eye. Oxybuprocaine was discontinued and both eyes were patched.Despite the discontinuation of the topical anaesthetic the patient persisted in having corneal epithelial 202defects and developed corneal oedema and a subepithelial peripheral ring infiltrate. He was admitted to hospital and put on topical dexamethasone 0 05% eye drops without preservative to both eyes every three hours and topical atropine 1% eye drops once daily. ' The corneal epithelial defects showed slow but progressive improvement and evidence of re-epithelialisation. The peripheral corneal ring infiltrate persisted in the left eye and partially resolved in the right eye (Fig. 1). The patient was discharged from hospital, and over the next six days the right corneal epithelial defect healed, leaving residual stromal oedema. The left cornea showed a central corneal ulcer, and corneal scrapings contained Staphylococcus epidermidis. Steroids were discontinued and the ulcer responded to topical antibiotics. His final best corrected vision was counting fingers at 5 feet (1.5 m) in the right eye and 20/80 in the left eye. CASE 2A 39-year-old Saudi male presented with a history of foreign body in the left eye. He had gone to a pharmacy where he received a bottle of oxybuprocaine 0-4% (Novesin). He instilled the eye drops in the left eye once every hour. On ex...

Endogenous bacterial endophthalmitis in infants is uncommon. We recently examined and treated an infant who presented with pink hypopyon which followed a Serratia marcescens septicaemia. Culture ofthe aspirate from the anterior chamber showed no red blood cells, and grew Serratia marcescens, which was also isolated from the tip of the child's umbilical artery catheter. The presence of a pink hypopyon in the absence ofhyphaema may suggest the diagnosis of Serratia marcescens endophthalmitis. (BrJ Ophthalmol 1992; 76: Case report After an uneventful pregnancy, a healthy 18-year-old primigravida had an uncomplicated labour and delivered a 2-65 kg full term infant. The neonate required resuscitation after delivery. Apgar scores were 1 at 5 minutes, 3 at 6 minutes, and 5 at 10 minutes. During the first few hours of life, the baby developed convulsions and was treated with 60% oxygen and phenobarbitone. Three days later the infant developed clinical signs of septicaemia and disseminated intravascular coagulopathy. Serratia marcescens was isolated from blood cultures and from the infant's ear, nose, and throat. S marcescens was also cultured from the tip of the child's umbilical artery catheter.Ophthalmic examination disclosed a normal right eye. The left cornea was hazy centrally. A fibrinous exudate was seen in the anterior chamber occluding the pupil and precluding visualisation of the fundus. A pink hypopyon occupied one third of the anterior chamber.

SUMMARY Corneal tissue absorption and intraocular penetration of fusidic acid were assessed in the rabbit after topical or subconjunctival application. Corneal tissue levels of fusidic acid one hour after the last topical application of the drug were well above the minimum inhibitory concentrations (MICs) for most Gram-positive and many Gram-negative organisms. Adequate levels were achieved in the aqueous at one hour following the last topical application, but no significant levels were detected in the vitreous. The corneal tissue and aqueous levels declined at 12 and 24 hours following the last drug application, however, corneal tissue levels at 24 hours were considered to be above the MICs for most Gram-positive organisms. A single subconjunctival injection of 100 mg of fusidic acid produced levels above the MICs of most organisms in the cornea, aqueous, and vitreous which persisted over 24 hours, but subconjunctival injection of fusidic acid at this concentration resulted in conjunctival necrosis and corneal decompensation. Fusidic acid penetrates well into avascular tissue and fully penetrates corneas with both intact and debrided epithelium, as evidenced by the intracameral drug levels. Good corneal penetration and absence of known topical toxicity make fusidic acid suitable for the treatment of microbial keratitis caused by susceptible organisms.

Behçet's disease is a multisystem disorder affecting the skin, mucous membranes, eye, joints, central nervous system, and blood vessels. One of the known vascular complications of Behçet's disease is venous thrombosis or aneurysm formation. We report, herewith, a patient with Behçet's disease who developed radial artery aneurysm, deep venous thrombosis, and bilateral central retinal vein thrombosis. To our knowledge, this is the first report of bilateral central retinal vein thrombosis in association with Behçet's disease.