No Pain, No Gain – Topical Anesthesia-Induced Keratopathy

Background

Topical anesthesia is an indispensable element of modern ophthalmic practice, most valuable during minor procedures and ocular examinations. However, regularly applied and prolonged use of local anesthetics may cause significant ocular damage. The spectrum of adverse effects is heterogeneous, ranging from mild conjunctival injection with superficial punctate keratopathy to persistent corneal epithelial defects, endothelial decompensation, ulcer formation, secondary infectious keratitis, and possible corneal perforation [1], [2]. Hence, timely identification of the underlying cause is essential to initiate targeted therapeutic measures. However, as topical anesthesia-induced keratopathy is a rare entity in Switzerland and its clinical picture may resemble infectious keratitis [3], the ophthalmologistʼs initial diagnosis poses a challenging task. This case report aims to further raise awareness about topical anesthetic abuse keratopathy.

Publication History

Received: 16 October 2022

Accepted: 05 January 2023

Article published online:
25 April 2023

• References

• 1 Yagci A, Bozkurt B, Egrilmez S. et al. Topical anesthetic abuse keratopathy: a commonly overlooked health care problem. Cornea 2011; 30: 571-575
• 2 Erdem E, Undar IH, Esen E. et al. Topical anesthetic eye drops abuse: are we aware of the danger?. Cutan Ocul Toxicol 2013; 32: 189-193
• 3 Rosenwasser GO, Holland S, Pflugfelder SC. et al. Topical anesthetic abuse. Ophthalmology 1990; 97: 967-972
• 4 Boljka M, Kolar G, Vidensek J. Toxic side effects of local anaesthetics on the human cornea. Br J Ophthalmol 1994; 78: 386-389
• 5 Wen Q, Fan T, Bai S. et al. Cytotoxicity of proparacaine to human corneal endothelial cells in vitro . J Toxicol Sci 2015; 40: 427-436
• 6 Fan WY, Wang DP, Wen Q. et al. The cytotoxic effect of oxybuprocaine on human corneal epithelial cells by inducing cell cycle arrest and mitochondria-dependent apoptosis. Hum Exp Toxicol 2017; 36: 765-775
• 7 Versura P, Giannaccare G, Pellegrini M. et al. Neurotrophic keratitis: current challenges and future prospects. Eye Brain 2018; 10: 37-45
• 8 Rosenwasser GO. Complications of topical ocular anesthetics. Int Ophthalmol Clin 1989; 29: 153-158
• 9 Tok OY, Tok L, Atay IM. et al. Toxic keratopathy associated with abuse of topical anesthetics and amniotic membrane transplantation for treatment. Int J Ophthalmol 2015; 8: 938-944
• 10 Yeniad B, Canturk S, Esin Ozdemir F. et al. Toxic keratopathy due to abuse of topical anesthetic drugs. Cutan Ocul Toxicol 2010; 29: 105-109
• 11 Vaidyanathan U, Hopping GC, Liu HY. et al. Persistent Corneal Epithelial Defects: A Review Article. Med Hypothesis Discov Innov Ophthalmol 2019; 8: 163-176