Keratopathy due to ophthalmic drug abuse with corneal melting and perforation presenting as Mooren-like ulcer: A case report

Abstract

The present report describes the clinical course and treatment of a Mooren-like ulcer associated with abuse of topical anesthetics and dexamethasone. A 38-year-old male physician treated himself with lidocaine, tetracaine and dexamethasone (DEX) eye drops for severe pain and decline of vision in both eyes. After six months of treatment, his right cornea exhibited annular melting with full-thickness stromal infiltration at the limbus and central corneal haze. His left cornea was completely melted and exhibited iris prolapse. The patient was treated with topical antibiotics, lubricants and underwent a binocular keratoplasty. The surgery was successful and after eight months the postoperative best-corrected visual acuities were counting fingers in the right eye and light perception in the left eye. In summary, this report documents a severe case of keratopathy presenting as Mooren-like ulcer caused by topical anesthetics and DEX, which were treated via keratoplasty, resulting in useful vision being retained.

Keywords: anesthetic abuse; dexamethasone; keratopathy; keratoplasty.

Figure 1.

Slit lamp images of both eyes prior to and following surgery. (A) Right eye at first admission: An annular corneal thinning 2–2.5 mm to the limbus is shown and spots of gray opacity in the central cornea. (B) Left eye at first admission: A thinning of the whole cornea with a perforation ~2.5×2 mm filled with iris on the central cornea, and the anterior chamber disappeared. (C) Right eye at second admission: The cornea was gray and opaque, thin and with neovascularization. There was a perforation ~5×4 mm filled with iris at the bottom of the central cornea, and the anterior chamber disappeared. (D) Right eye after the surgery: The graft was transparent and in location with a normal anterior chamber. (E) Left eye, 8-months postsurgery: Proliferated bulbar conjunctiva and new vessels covered most of the corneal tissue.

Figure 2.

Histological sections of the right cornea stained with hematoxylin and eosin. (A) Infiltration of a large number of neutrophils, lymphocytes, and plasma cells in the cornea. The arrow shows a large area of typical hyaline degeneration in the corneal stroma (magnification, ×100). (B) Hyperplasia and neovascularization of the corneal epithelium. The arrow indicates infiltration of a large number of neutrophils, lymphocytes and plasma cells in the cornea (magnification, ×200).