TOPICAL ANESTHETIC ABUSE RING KERATITIS - REPORT OF 4 CASES

Purpose, We present the clinicopathologic correlations of two cases an d two other clinical cases of topical anesthetic abuse keratopathy tha t were originally diagnosed as Acanthamoeba keratitis because of ring keratitis presentation and characteristic history. Methods, Four patie nts who were referred to us with suspected Acanthamoeba keratitis are included. Each was initially treated for amoebic keratitis, by using e stablished protocols, and only later was the true origin (topical anes thetic abuse) uncovered, The clinical and surgical histories, patholog ic analysis of the corneal specimens, and follow-up of less than or eq ual to 4 years are included. Results, Our four cases shaw another caus e for ring infiltration of the cornea. Two cases resulted in corneal t ransplantation and multiple other medical or surgical treatments in an attempt to restore vision but had pour outcomes of finger-counting vi sion, Two other cases responded to intensive medical treatments with r eturn of useful vision. Evaluation of the surgical specimens revealed a previously unpublished finding of near total cell death within the c orneal stroma. Conclusion, Topical anesthetic abuse resulting in sight -threatening keratitis may be seen as a masquerade syndrome in many ca ses. Because of the often poor outcome, we must be aware of this entit y, prevent abuse, and be vigilant in our prohibition of topical anesth etic for any therapeutic use.