Topical Anesthetic - Abuse When Used For Ocular Pain Relief

Abuse When Used For Ocular Pain Relief

When used excessively, topical anesthetics can cause severe and irreversible damage to corneal tissues and even loss of the eye. The abuse of topical anesthetics often creates challenges for correct diagnosis in that it is a relatively uncommon entity that may initially present as a chronic keratitis masquerading as acanthamoeba keratitis or other infectious keratitis. When a keratitis is unresponsive to treatment and associated with strong ocular pain, topical anesthetic abuse should be considered, and a history of psychiatric disorders and other substance abuse have been implicated as important factors in the diagnosis. Because of the potential for abuse, clinicians have been warned about the possibility of theft and advised against prescribing topical anesthetics for therapeutic purposes.

Some patients who suffer from eye pain, which is often considerably strong neuropathic pain caused by the irritation of the nerves within the cornea and/or conjunctiva, unfortunately try to illegally obtain oxybuprocaine or other eye anesthetics (for example by stealing them at their ophthalmologist or optometrist, by forging medical prescriptions or by trying to order it via an online pharmacy) and secretly use the substance to numb their eye pain, often ending up with irreversible corneal damage or even destruction (which is a vicious cycle and causes even much more pain). Often, such patients finally require corneal transplantation.

In case of prolonged or chronic eye pain, especially neuropathic eye pain, it is highly advisable to use centrally acting substances like anticonvulsants (pregabalin, gabapentin and in more serious cases carbamazepine) or antidepressants (for example SSRIs or the tricyclic antidepressant amitriptyline). Even very small amounts of an anticonvulsant and/or an antidepressant can almost completely stop eye pain and does not damage the eye at all.