Clinical findings in patients with topical anaesthetic abuse keratitis: a report of five cases.

Objective: The purpose of this study is to describe the clinical findings in five patients with topical anaesthetic abuse.

Methods: Five patients presented in the emergency department with persistent corneal epithelial defects associated with a ring infiltrate in the corneal stroma, without any referred history of ocular trauma or ocular application of any corrosive or alkali substance. The patients were hospitalised and a thorough ocular examination was accomplished. Systemic evaluation and psychiatric consultation were also done.

Results: A detailed history in all our patients revealed topical anaesthetic abuse keratitis. The topical anaesthetic was deliberately taken from the pharmacy without medical prescription. In all our patients a psychiatric disease and/or drug abuse was disclosed after psychiatric examination. The hallmark of topical anaesthetic abuse keratitis was a persistent corneal epithelial defect and a complete or incomplete ring infiltration of the corneal stroma in all cases. Functional and anatomic results after the appropriate treatment were not favourable in the majority of the cases, leading in some of them to blindness.

Conclusions: Although topical anaesthetic abuse keratitis is rare, it should be considered in the differential diagnosis when we see a patient with a persistent corneal epithelial defect together with a ring infiltration on the corneal stroma. Psychiatric diseases and/or systemic drug abuse are usually associated with this toxic keratopathy. The psychiatric diseases that accompany this toxic keratopathy may also lead to death or to severe handicap as a result of suicide attempts by the patients. Psychiatric consultation and therapy are imperative in the management of such patients.