Background: A 54-year-old man presented complaining of severe pain and blurred vision in
his left eye. Slit-lamp biomicroscopy revealed a large epithelial defect with an underlying prominent
ring infiltrate and severe anterior uveitis with fibrinous exudates and hypopyon. Patient admitted abuse
of topical tetracaine, which was discontinued and topical treatment with a non-steroidal antiinflammatory
agent, an antibiotic, a cycloplegic agent were instituted while a therapeutic contact lens
was applied. Response to treatment was favorable with a rapid resolution of anterior uveitis within days
while the epithelial defect fully healed within a month. Four months later the patient returned with a new
subtotal epithelial defect with no previous history of trauma or topical anesthetic abuse.
Conclusion: In conclusion, while a common complication of topical tetracaine abuse is toxic
keratopathy, we describe a case where tetracaine abuse was also complicated with a severe fibrinous
anterior uveitis. Interestingly, in our case, anaesthetic abuse was complicated in the mid-term with a
spontaneous corneal epithelial defect attributed to possible anaesthetic-induced anatomical changes,
such as poor adhesion between the stroma and the epithelium.