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Abuse of topical anaesthetic agents is a rare but potentially dangerous cause of toxic keratitis. Persistent use of topical anaesthetics may result in severe pain, hyperaemia, mucopurulent discharge, chronic epithelial defects, stromal infiltrates with oedema and neovascularisation, and even hypopyon or hyphaema.1 Permanent corneal scarring and visual loss may lead to penetrating keratoplasty and enucleation.2 Patients have obtained anaesthetic drops from eye care practitioners and pharmacists, from theft of the practitioners' offices, and over the counter in some developing countries.2–4 We present a case of toxic keratitis secondary to topical anaesthetic abuse that is unique in two aspects. Firstly, the patient received the drops directly from an emergency department physician and, secondly, the patient developed an ulcerative keratitis months after the cornea had re-epithelialised.
CASE REPORT
A 24 year old woman presented with complaints of decreased vision and severe eye pain bilaterally. Two weeks before presentation, she had a history of intensely pruritic allergic conjunctivitis. She was examined by a community hospital emergency department physician, who reportedly treated her for a corneal abrasion in the right eye. Two ophthalmologists subsequently treated her for presumed bilateral bacterial keratitis that worsened despite aggressive topical antibiotic therapy, and the patient was referred to the UMDNJ-New Jersey Medical School ophthalmology department. The patient was not a contact lens wearer, and she denied tap or pool water exposure. Past medical history was unremarkable.
On examination, visual acuity was hand movements in both eyes. The eyelids were oedematous and the …
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