Topical Anesthetic Abuse Keratopathy: A Commonly Overlooked Health Care Problem

Abstract

Ophthalmologists should be suspicious of topical anesthetic abuse keratopathy in young male manual laborers specialized in welding business and foundry work presenting with persistent epithelial defects, ring-shaped keratitis, and accompanying severe ocular pain.

Metal Workers with Corneal Injuries and Abuse of Topical Drugs

“…The long-term use of topical Diclofenac following ocular surgery has been reported to cause corneal melting (23). On the other hand, the long-term use of topical 0.05% Proparacaine HCl drop may lead to several eye problems, including superficial punctate keratopathy, persistent epithelial defects, stromal infiltrates, and secondary infectious keratitis (10)(11)(12)(13). Keratoplasty may be necessary in cases with corneal abscess due to the abuse of eye drops (13).…”

“…Workers who were using unprescribed drugs were informed about their effects, side effects, and possible complications. Due to the high reported complications and side effects of Proparacaine HCl (10)(11)(12)(13), it has been forbidden to be sold without prescription in Turkey.…”

“…Serious side effects, especially due to the unprescribed use of drugs, which may result in keratoplasty, have been reported (10)(11)(12)(13). It is known that the appropriate use of safety equipment, such as goggles, decreases the risk of eye injuries (1,3,9,14).…”

Metallic corneal foreign bodies: an occupational health hazard

“…Improper use of topical anesthetic agents results in superficial punctate keratitis, persistent corneal epithelial defects, ring-like or dis ciform stromal infiltration, endothelial cell loss, secondary infectious keratitis, and even corneal melting and perforation. This can result in permanent vision loss in severe cases that are not diagnosed or properly treated (2)(3)(4) . Therefore, TAAK has been a major health problem in these workers, particularly in developing countries.…”

“…Topical anesthetics are mainly abused by young male manual laborers who are exposed to arc welding flash, metallic FB injuries and chemical injuries while working in welding operations and foundries (2) . Improper use of topical anesthetic agents results in superficial punctate keratitis, persistent corneal epithelial defects, ring-like or dis ciform stromal infiltration, endothelial cell loss, secondary infectious keratitis, and even corneal melting and perforation.…”