Sequential Bilateral Mooren's-Like Peripheral Ulcerative Keratitis Following Topical Anesthetic–Induced Toxic Keratitis: A Case Series

To describe sequential bilateral Mooren-like peripheral ulcerative keratitis associated with topical anesthetic abuse and to highlight the importance of early controlled anti-inflammatory therapy in preventing progressive corneal melt and visual loss.

Cornea unit at the memorial institute for ophthalmic research 

This retrospective observational case series included nine patients with documented topical anaesthetic abuse presenting with peripheral corneal ulceration at a tertiary ophthalmology center. Particular attention was given to the temporal sequence of ocular involvement, prior management patterns, and response to a structured treatment protocol consisting of anaesthetic cessation, low-dose topical dexamethasone, prophylactic moxifloxacin, cycloplegia, and bandage contact lens application.

Nine male patients (age range 28–47 years) were included. Eight of nine patients (88.9%) developed bilateral disease. In most cases, involvement was sequential, with initial toxic keratopathy affecting one eye followed by delayed Mooren-like peripheral ulceration in the fellow eye after a mean interval of approximately two weeks. Many patients had previously received intensive antimicrobial therapy without corticosteroids and showed no improvement. Following implementation of the structured protocol, rapid pain relief and clinical stabilization were observed. Fellow eyes demonstrated marked responsiveness to corticosteroid therapy. Visual acuity improved from hand motions at presentation to as high as 0.9 at 4 weeks in responsive cases. 

Topical anesthetic abuse may precipitate sequential bilateral Mooren-like peripheral ulceration with a significant inflammatory component. Failure to recognize this pattern may delay appropriate therapy and contribute to progressive stromal melt. Early introduction of controlled corticosteroid therapy following exclusion of infection may be vision-saving.