Toxic ulcerative keratopathy. An unrecognized problem.

The authors describe 19 patients with toxic ulcerative keratopathy. These patients were referred with other diagnoses and were victims of overtreatment. Fourteen of these patients had iatrogenic toxic keratopathy, and the other five had self-induced keratoconjunctivitis. The corneal defects tended to be inferior or inferonasal and associated with an intense, coarse superficial keratitis in "comet's impact" fashion. Conjunctival hyperemia, chemosis, and conjunctival staining were considerably more prominent inferiorly and inferonasally. Diagnosis was the key element in management. Treatment consisted of discontinuation of the offending medication or preservative. Other important measures included preservative-free medications, patching, therapeutic contact lenses, goggles, and viscoelastic agents. Many of the patients with iatrogenically induced toxic keratopathy had significant ocular surface disease such as keratoconjunctivitis sicca (6 patients), previous intraocular surgery (6 patients), herpes simplex infection (1 patient), or herpes zoster infection (1 patient).