Severe toxic keratopathy secondary to topical anesthetic abuse.

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.