Clinical Findings in Patients with Topical Anaesthetic Abuse Keratitis: a Report of Five Cases

Abstract

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.

The Misuse and Abuse of Ophthalmic Preparations: a Scoping Review of Clinical Case Presentations and Extant Literature

“…Different ocular disorders have been associated with the abuse of these drugs, including keratopathy, stromal infiltrates, persistent epithelial defects, and secondary infectious keratitis and may lead to corneal melting, permanent visual loss, and perforation (Rosenwasser et al 1990;Chern et al 1996;Flach 2001;Yeniad et al 2010;Hendershot et al 2011;Erdem et al 2013;Sharifi et al 2013;Tok et al 2015). Misuse of topical ophthalmic anaesthetics causes anesthetic induced keratitis (Henkes and Waubke 1978;Webber Frcophth et al 1999;Goldich et al 2011;Kurna et al 2012;Matti and Saha 2012;Wu et al 2016), bilateral corneal ring infiltrates (Rapuano 1990;Katsimpris et al 2007), toxic keratopathy (Risco 1993;Varga et al 1997;Chen et al 2004;Rao et al 2007;Kirikkaya et al 2013), candida keratitis (Chern et al 1996), stromal infiltration (Sugar 1998;Kim et al 1997), and infectious crystalline keratopathy (Kintner 1990). Acute and chronic conjunctivitis generally occur as a result of the excessive use of ophthalmic decongestants (Soparkar et al 1997;Tappeiner et al 2009;Kadri et al 2010).…”

“…Additional patient vulnerability to co-morbid conditions such as personality disorder, bi-polar disorder, anxiety disorder, chemical dependence, depression, and suicidal ideation are evident (Rosenwasser 1990;Ansari et al 2005;Katsimpris et al 2007;Yeniad et al 2010;Yagci et al 2011;Erdem et al 2013;Toc et al 2015). Therefore, psychiatric diagnosis is a vital component of the clinical care pathway (Ansari et al 2005).…”

“…This case report revealed that abusers obtained eye drops from ophthalmologists and pharmacies, along with thefts from clinics. Katsimpris et al (2007) keratitis. Authors reported that topical anaesthetic abuse keratopathy is usually a phenomenon of underlying psychiatric disorder, and psychiatric consultation is a very critical part of treatment (Ansari et al 2006).…”

Topical Anesthetic Misuse in Patients Admitted to Sabzevar Eye Clinic in Iran

“…In another study by Erdem and coworkers, the misuse of topical anesthetic eye drops abuse was shown from 12 eyes of 8 patients who were evaluated retrospectively, and one of the patients provided the drug with a primary care practitioner's prescription, but for the other 7 patients, it was available from pharmacies without prescription (11). Also, Katsimpris and coworkers described the clinical findings in five patients with topical anesthetic abuse with a detailed history in all patients; it was revealed that topical anesthetic abuse led to keratitis by obtaining anesthetic drops from the pharmacy without medical prescription (12). However, in the present study, 21.6% of all patients with different occupations provided the drug from drugstores without doctor's prescription, and only 3.7% provided drugs by physician's prescription.…”

Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: A case report

“…However, diagnosis of keratopathy due to drug abuse is often delayed as the clinical manifestations are common to other diseases such as acanthamoeba keratitis, bacterial keratitis, viral keratitis and single cell virus keratitis (23,24). Furthermore, the diagnosis may be complicated if the patient cannot accurately identify the eye drops they have used (25). A thorough history and consideration of the specific eye drops used are crucial for the accurate diagnosis of drug-induced keratopathy (26).…”