Anesthetic keratopathy presenting as bilateral Mooren-like ulcers

Abstract

This observational case report describes the development of bilateral Mooren-like ulcers in a patient with anesthetic keratopathy. A 42-year-old man with a recent history of minor eye trauma and pain self-treated with tetracaine eye drops presented with complaints of acutely worsening vision and severe pain bilaterally. His visual acuity at presentation was limited to hand motion. Slit-lamp examination revealed bilateral epithelial defects at the center of the cornea, and an area of stromal infiltration and thinning with an undermining leading edge resembling a Mooren's ulcer in both eyes. Corneal haze and hypopyon were visible. Anesthetic use was halted immediately and the patient was started on prednisolone and mycophenolate mofetil (Cellcept(®)), after which visual acuity gradually improved and pain decreased. Despite improvement of symptoms, residual epithelial defects remained, and the patient was ultimately treated with keratoplasty for recovery of vision. We suggest that anesthetic keratopathy should be included in the differential diagnosis for any patient presenting with ring-shaped stromal infiltrates or nonhealing epithelial defects.

Keywords: anesthetic abuse; corneal damage; corneal ulceration.

Figure 1

Corneal Haze in a Patient with Anesthetic Keratopathy. Notes: Figure demontrates a central persistent epithelial defect with underlying stromal haze in a ring like distribution in a patient with a history of topical anesthetic abuse. The prominent corneal neovascularization approaching the visual axis. Peripheral thinning at the limbus is present for nearly 360 degrees.

Figure 2

Corneal Ulceration in Anesthetic Keratopathy Resembling Mooren’s Ulcer. Note: Figure demonstrates 360 degrees of corneal thinning at the limbus with a noticeable undermined edge, diffuse corneal haze is also observed.