Anaesthetic abuse keratopathy as a manifestation of ocular Munchausen's syndrome

Two patients, both with a history of major depressive disorder, presented with large bilateral corneal epithelial defects and ring-shaped stromal opacities. Both were initially treated unsuccessfully with topical antibiotic therapy for presumed infectious keratitis. One patient eventually admitted to topical anaesthetic abuse. In the second patient, signs of topical anaesthetic abuse and Munchausen's syndrome became evident. Cessation of anaesthetic use resulted in rapid resolution of the corneal epithelial defects in both patients. Anaesthetic abuse keratopathy is often a manifestation of underlying psychiatric illness, and psychiatric intervention is a very important part of management. To the author's knowledge, this is the first report of ocular Munchausen's syndrome manifesting as anaesthetic abuse keratopathy.