title: Topical anesthetic abuse keratitis secondary to floppy eyelid syndrome.
abstract: OBJECTIVE
  To report the diagnosis and management of a patient with chronic ophthalmic topical anesthetic abuse and floppy eyelid syndrome.
  
  
  METHODS
  We describe the case of a 47-year-old man suffering from persistent bilateral ocular irritation and chronic corneal erosions.
  
  
  RESULTS
  The patient was hospitalized in our ophthalmology department and underwent thorough ophthalmic, systemic, and psychiatric evaluation. Chronic topical anesthetic abuse was discovered. Removal of abused drops and copious lubricating treatment lead to partial improvement further permitting diagnosis of floppy eyelid syndrome. Definitive surgical treatment by horizontal eyelid tightening combined with continuous lubrication resulted in remission of symptoms.
  
  
  CONCLUSIONS
  Uncommon conditions may coexist in 1 patient. In this case, floppy eyelid syndrome resulted in topical anesthetic abuse. Ophthalmologists should keep both these conditions in mind when treating patients with otherwise unexplained chronic persistent corneal erosions.
authors.affiliation: Department of Ophthalmology, Assaf Harofeh Medical Center, Tel-Aviv University, Tel-Aviv, Israel. doctor.goldich@gmail.com
authors.forename: Yakov
authors.initials: Y
authors.lastname: Goldich
authors.forename: David
authors.initials: D
authors.lastname: Zadok
authors.forename: Isaac
authors.initials: I
authors.lastname: Avni
authors.forename: Morris
authors.initials: M
authors.lastname: Hartstein
mesh_terms: D000779:Anesthetics, Local / Q000009:adverse effects*; D005141:Eyelid Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007634:Keratitis / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D011343:Procaine / Q000009:adverse effects / Q000031:analogs & derivatives*; D012651:Self Medication / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000209:etiology*; D013577:Syndrome
chemical_list: D000779:Anesthetics, Local; D011343:Procaine; C005298:benoxinate