Two Cases of Corneal Ring Infiltrates from Topical Anesthetic Abuse

ABSTRACT

PURPOSE: Topical anesthetic abuse resulting in sight-threatening keratitis may be seen as a masquerade syndrome in many cases because of ring infiltration of the cornea. The authors report two cases of keratopathy from topical anesthetic abuse that were originally suspected as infectious keratitis because of ring infiltration of the cornea METHODS: The medical records of two patients were retrospectively reviewed. The pathogenesis, diagnosis, and treatment of ring infiltrates were evaluated. RESULTS: The two patients presented a nonhealing epithelial defect, marked stromal edema, folds in Descemet's membrane, and typical stromal ring infiltrates of unknown etiology. The patients initially were treated empirically with antibacterial and antifungal agents in suspicion of infectious keratitis. These patients had sustained severe ocular pain, and chronically used topical anesthetics (0.5% proparacaine hydrochloride in one patient and 0.4% benoxinate hydrochloride in the other) for several weeks. All microbiology work-ups for the identification of infectious organisms including acanthamoeba were negative. After topical anesthetic was discontinued in two patients, amniotic membrane transplantation was performed on one patient. Corneas in two patients were re-epithelialized with mild scarring with topical antibiotic and steroid treatment.