This may be surprising to many of you, but some of our patients abuse medication.  In addition to Dilaudid, morphine, and Percocet, lets add topical ophthalmic anesthetics such as tetracaine to our “red flag” list.  The most common offenders are young male manual laborers particularly those involved in welding and foundry.

Even when diluted, topical ophthalmic anesthetics can directly injure corneal epithelium, stroma and endothelium; the inflammatory response to the direct injury can further damage delicate ophthalmic structures.  This form of keratitis is often misdiagnosed as acanthamoeba keratitis.

The following lists complications that have been documented from topical ophthalmic anesthetic abuse.

Chronic keratitis

Fungal keratitis

Superficial punctate keratitis

Stromal/ring infiltrates

Corneal edema

Corneal perforation

Remember for your eye injury patients, provide adequate pain control to help avoid topical anesthetic abuse.


Patel M, Fraunfelder FW. Toxicity of topical ophthalmic anesthetics. Expert Opin Drug Metab Toxicol. 2013 Aug;9(8):983-8. doi: 10.1517/17425255.2013.794219. Epub 2013 Apr 25. Review.

Pharmakakis NM, Katsimpris JM, Melachrinou MP, Koliopoulos JX. Corneal complications following abuse of topical anesthetics. Eur J Ophthalmol. 2002 Sep-Oct;12(5):373-8.

Chern KC, Meisler DM, Wilhelmus KR, Jones DB, Stern GA, Lowder CY. Corneal anesthetic abuse and Candida keratitis. Ophthalmology. 1996 Jan;103(1):37-40.

Yagci A, Bozkurt B, Egrilmez S, Palamar M, Ozturk BT, Pekel H. Topical anesthetic abuse keratopathy: a commonly overlooked health care problem. Cornea. 2011 May;30(5):571-5.