SEVERE TOXIC KERATOPATHY SECONDARY TO TOPICAL ANESTHETIC ABUSE

Objective: To describe the clinical findings in three cases of abuse o f topically administered ophthalmic anesthetics and to review the clin ical signs, diagnosis and treatment. Design: Case series. Setting: Two university-affiliated hospitals in Montreal. Patients: Three patients with toxic keratopathy due to abuse of topically applied anesthetics. Results: The three patients presented with a nonhealing epithelial de fect, marked stromal edema, folds in Descemet's membrane and a typical stromal ring infiltrate, All three required a conjunctival flap, and two underwent penetrating keratoplasty. The drugs (0.5% tetracaine and 0.5% proparacaine) were easily obtained, at: the workplace in two cas es and by stealing from the ophthalmologist's examining room in the th ird case. Conclusions: The unrestricted availability of topically appl ied ophthalmic anesthetics as over-the counter medications in Canada m ust be reevaluated.