Corneal Complications following Abuse of Topical Anesthetics

Abstract

The initial presentation of this rare clinical entity creates difficulties in reaching a correct diagnosis. A presumed acanthamoeba keratitis is the first choice among many similar conditions. Thus abuse of topical ocular anesthetic drops should be included in the differential diagnosis of cases of chronic keratitis as it may masquerade as acanthamoeba keratitis. A current or past history of psychiatric and mental disorders or psychoactive substance abuse is important in the diagnosis. Functional and anatomical results after appropriate treatment are usually poor. Psychiatric counselling is extremely helpful and is in fact mandatory in the management of these patients.

Acanthamoeba keratitis with perforation after corneal crosslinking and bandage contact lens use

“…Several adverse ocular reactions, mainly involving long-term abuse, have been reported. [23][24][25][26] A direct toxic effect on epithelial cells and stromal keratocytes has been shown. 27,28 We cannot exclude the possibility that the use of topical anesthetic eyedrops may have had an adjunctive deleterious effect in promoting stromal tissue melting.…”

Toxic Keratopathy Associated With Abuse of Low-Dose Anesthetic

“…Topical anesthetic abuse has been reported to cause mild to severe corneal disorders, [3][4][5][6][7][8] including superficial punctate keratopathy, persistent epithelial defect, Wessely immune ring-like or disciform stromal infiltration, stromal edema, Descemet membrane folding, and endothelial cell loss. More devastating side effects, such as neurotrophic ulcer, secondary infectious keratitis, corneal perforation, and subsequent permanent visual loss may also develop.…”

Mechanical ocular surface injuries caused by careless handling of topical agents

“…[1][2][3] Topikal anesteziklerin bilinçsizce ve sık kullanımı korneal hipoesteziye, nöroparalitik keratite ve immünolojik halka reaksiyonlara sebep olur. [4][5][6] Diğer rastlanılabilecek yanıltıcı göz travmalarına simulasyon, Munchausen sendromu veya mental retardasyona bağlı oluşturulan travmalar ile rastlamak müm-kündür. Göz ilaçlarının yanlış uygulanması ise farklı bir klinik tarifi ortaya çıkarmaktadır.…”