Hou Yu-Chih, Wang I-Jong, Hu Fung-Rong
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2009 Dec;108(12):967-72. doi: 10.1016/S0929-6646(10)60011-3.
Anesthetic toxic keratitis is rare and presents as a ring keratitis, which is often misdiagnosed as Acanthamoeba keratitis. Here, we report an unusual case of toxic keratitis caused by topical abuse of a dilute anesthetic. A 26-year-old woman presented with bilateral corneal edema, ring infiltrates, pigmented keratic precipitate, Descemets membrane folding, and strong anterior chamber reactions 2 weeks after laser subepithelial keratomileusis surgery. Tracing back her medical history, topical dilute 0.1% proparacaine was prescribed and frequently used for 1 month. Toxic keratitis was suspected. After discontinuation of the topical anesthetic and initiation of treatment with topical 20% autologous serum, complete corneal epithelialization was achieved within 1 week. Corneal infiltrates and anterior chamber reaction gradually subsided. Vision improved from finger counting to 20/20 in the right eye and 20/25 in the left eye, but confocal microscopy showed decreased corneal endothelial cells. Topical abuse of a dilute topical anesthetic can cause severe toxic keratitis and endothelial cell loss. The physician must be aware of the signs of topical anesthetic abuse and should not prescribe even a dilute anesthetic for long-term use. Autologous serum can help in the recovery of toxic keratitis.
麻醉性毒性角膜炎较为罕见，表现为环形角膜炎，常被误诊为棘阿米巴角膜炎。在此，我们报告一例因局部滥用稀释麻醉剂导致的罕见毒性角膜炎病例。一名26岁女性在准分子激光上皮下角膜磨镶术（LASEK）手术后2周出现双侧角膜水肿、环形浸润、色素性角膜后沉着物、Descemet膜折叠及强烈的前房反应。追溯其病史，曾开具0.1%的稀释丙美卡因并频繁使用达1个月。怀疑为毒性角膜炎。停用局部麻醉剂并开始使用20%的自体血清局部治疗后，1周内角膜完全上皮化。角膜浸润和前房反应逐渐消退。视力从右眼手动视力提高到右眼20/20、左眼20/25，但共焦显微镜检查显示角膜内皮细胞减少。局部滥用稀释的局部麻醉剂可导致严重毒性角膜炎和内皮细胞丢失。医生必须意识到局部麻醉剂滥用的迹象，不应开具即使是稀释的麻醉剂用于长期使用。自体血清有助于毒性角膜炎的恢复。
