title: Severe toxic keratopathy secondary to topical anesthetic abuse.
abstract: OBJECTIVE
  To describe the clinical findings in three cases of abuse of topically administered ophthalmic anesthetics and to review the clinical signs, diagnosis and treatment.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Two university-affiliated hospitals in Montreal.
  
  
  METHODS
  Three patients with toxic keratopathy due to abuse of topically applied anesthetics.
  
  
  RESULTS
  The three patients presented with a nonhealing epithelial defect, marked stromal edema, folds in Descemet's membrane and a typical stromal ring infiltrate. All three required a conjunctival flap, and two underwent penetrating keratoplasty. The drugs (0.5% tetracaine and 0.5% proparacaine) were easily obtained, at the workplace in two cases and by stealing from the ophthalmologist's examining room in the third case.
  
  
  CONCLUSIONS
  The unrestricted availability of topically applied ophthalmic anesthetics as over-the-counter medications in Canada must be reevaluated.
authors.affiliation: Department of ophthalmology, McGill University, Montreal, Que.
authors.forename: G
authors.initials: G
authors.lastname: Rocha
authors.forename: I
authors.initials: I
authors.lastname: Brunette
authors.forename: M
authors.initials: M
authors.lastname: Le François
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000779:Anesthetics, Local; D002057:Burns, Chemical / Q000601:surgery; D003315:Cornea / Q000187:drug effects* / Q000601:surgery; D003316:Corneal Diseases / Q000139:chemically induced* / Q000601:surgery; D065306:Corneal Injuries; D005126:Eye Burns / Q000139:chemically induced; D005129:Eye Foreign Bodies / Q000601:surgery; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D011430:Propoxycaine; D012651:Self Medication; D019966:Substance-Related Disorders; D013748:Tetracaine; D014945:Wound Healing
chemical_list: D000779:Anesthetics, Local; D013748:Tetracaine; C005717:proxymetacaine; D011430:Propoxycaine