CORNEAL ANESTHETIC ABUSE AND CANDIDA KERATITIS

Purpose: Topical corneal anesthetic abuse is a self-inflicted injury, causing profound corneal morbidity. Superimposed infection is an impor tant complicating factor. The authors report four patients with confir med topical anesthetic abuse of the cornea, in whom Candida keratitis developed. Methods: A retrospective review of the medical records of f our patients with confirmed topical corneal anesthetic abuse and funga l keratitis. Results: A 21-year-old woman, two 28-year-old women, and a 35-year-old man were included in the study. All these patients susta ined a corneal injury, prompting the chronic use of topical anesthetic s (0.5% proparacaine hydrochloride in 3 patients, and 0.5% tetracaine hydrochloride and 0.4% benoxinate hydrochloride in the other). Corneal findings included epithelial defects in all patients, focal infiltrat e in one patient, and ring-shaped stromal infiltrate in three patients . Topical anesthetic was discontinued, all patients initially were tre ated empirically with antibacterial agents, and three patients receive d topical corticosteroids. Subsequent corneal cultures grew Candida sp p, Candida albicans specifically in three patients, and local and syst emic antifungal therapy was started. Corneas in two patients re-epithe lialized; a conjunctival flap was performed on another patient with a descemetocele; and the remaining patient was lost to follow-up, althou gh repeat fungal cultures yielded no growth. Conclusions: Corneal supe rinfection with Candida may occur during topical anesthetic abuse. The rapy includes discontinuation of the anesthetic and institution of ant ifungal therapy.