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Gewählte Publikation:

Ardjomand, N; Faschinger, C; Haller-Schober, EM; Scarpatetti, M; Faulborn, J.
A clinico-pathological case report of necrotizing ulcerating keratopathy due to topical anaesthetic abuse
Ophthalmologe. 2002; 99(11):872-875 (- Case Report)
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Autor/innen der Med Uni Graz:
Ardjomand Navid
Faschinger Christoph
Haller-Schober Eva-Maria
Scarpatetti Michael
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Abstract:
BACKGROUND: Topical anesthetic abuse is rare, but difficult to diagnose since most patients deny its use and the clinical changes are very similar to other corneal diseases. CASE REPORT: A 45-year-old medical doctor with a 30-year history of soft contact lens wear and recurrent corneal erosion was admitted to our clinic with a ring-shaped keratitis and intense ocular pain. A corneal smear was negative for bacterial infections and acanthamoeba but the contact lens box contained a few dead acanthamoeba and many cocci. Due to the clinical findings and the acanthamoeba found in the contact lens box acanthamoeba keratitis was diagnosed and treatment with gentamycin, pentamidine isethionat (Brolene((R))) and hexamidine (Desomedine((R))) was started. The clinical appearance did not change for 6 weeks after onset of treatment and a perforating corneal transplantation was performed for pain relief and visual rehabilitation. An iris ectropion lacking iris motility and dense cataract developed within 5 weeks and the patient admitted on direct questioning to having taken topical anesthetic (oxybuprocain) by self-medication. The histological investigation revealed few inflammatory cells. The epithelium was largely missing and few vital cells could be found in the stroma and the endothelial cell layer. Acanthamoeba could not be detected in the tissue. CONCLUSION: Topical anesthetic abuse can mimic different corneal diseases and be difficult to diagnose if the patient denies its use. In cases of keratitis with no response to treatment and strong ocular pain, topical anesthetic abuse should be considered.
Find related publications in this database (using NLM MeSH Indexing)
Acanthamoeba Keratitis - diagnosis
Anesthetics, Local - adverse effects
Contact Lenses, Hydrophilic - adverse effects
Diagnosis, Differential - adverse effects
Follow-Up Studies - adverse effects
Humans - adverse effects
Keratitis - chemically induced
Keratoplasty, Penetrating - chemically induced
Male - chemically induced
Middle Aged - chemically induced
Munchausen Syndrome - chemically induced
Substance-Related Disorders - diagnosis
Time Factors - diagnosis

Find related publications in this database (Keywords)
Acanthamoeba
keratopathy
topical anaesthetic abuse
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