A clinical case of corneotoxic damage caused by prolonged use of a local anesthetic

Abstract

A clinical case of a severe toxic lesion of the cornea in the form of an extensive ulcer in the only seeing eye (left) due to a prolonged use of the local anesthetic oxybuprocaine is presented. The patient (who had lost the object vision in the right eye after a penetrating injury of the eyeball) started using the drug for the first time on his own accord, without informing the attending physician, 2 months before referring himself to the Ufa Research Institute of Eye Diseases due to the development of recurrent keratoconjunctivitis, accompanied by severe pain. The patient combined oxybuprocaine instillations 4–6 times a day with the prescribed anti-inflammatory therapy, including local application of steroid drops. This led to the development of a corneal ulcer, complicated by a toxic allergic reaction. The fact of a long-term unauthorized use of oxybuprocaine was discovered in a confidential talk with the patient. Subsequent in-patient and long-term out-patient treatment involving reparative, anti-inflammatory, antibacterial and antiviral therapy, helped achieve gradual epithelialization of an extensive corneal defect resulting in vascularized opacification and an increase in visual acuity of the only seeing eye to 0.5 with correction. The case demonstrates the need to increase the awareness of ophthalmologists, who should not disregard possible corneotoxic lesions in their differential diagnosis. In addition, the patients should be informed about severe complications and their consequences associated with self-administration and prolonged use of local anesthetics.

Keywords

• keratitis
• oxybuprocaine
• corneotoxic effect
• corneal ulcer
• clinical case