Severe vernal keratoconjunctivitis complicated by anaesthetic abuse

      A 22-year-old man with a history of atopy and vernal keratoconjunctivitis presented for a nonhealing complete corneal epithelial defect of the right eye (Fig. A, B). Biomicroscopy was notable for giant papillae on everted lids (Fig. C). Infectious etiologies were ruled out. The patient disclosed a 2-week history of daily topical anaesthetics use. A diagnosis of severe vernal keratoconjunctivitis complicated by anaesthetic abuse was made. Despite outpatient treatment, he presented 1 month later with a dense sterile stromal infiltrate (Fig. D) owing to continued anaesthetic abuse and persistent epithelial defect. He was admitted to our inpatient service for cessation of topical anaesthetic use and pain management. His epithelial defect eventually healed with diffuse stromal haze, neovascularization, and limbal stem cell deficiency.
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