Toxic Keratopathy Associated with Topical Proparacaine Abuse-A Case Report

Purpose: To present a case of toxic keratopathy due to abuse of topical proparacaine eye drops. Methods: Observational case report. Results: A 24-year-old woman suffered from acute painful sensation of both eyes after putting on contact lenses soaked in hydrogen peroxide care solution. Bilateral punctate corneal epithelial erosions were diagnosed. To relieve pain, she, by herself, applied topical 0.5% proparacaine eye drops to both eyes with increasing frequency to almost hourly. However, the pain was aggravated. On examination 2 days later, a large central disciform epithelial defect and diffuse edema of the residual epithelium were noted in both corneas. With the treatment using non-preserved artificial tears, the epithelial defects started to heal the next day and ring-shaped stromal cellular infiltrates were observed at the border of previous epithelial defects. The epithelial defects of both corneas healed in 3 days and the ring infiltrates resolved completely in one month. Conclusions: Topical anesthetics abuse may lead to serious corneal pathologies. The pathogeneses of keratopathy will be discussed.