Complicated COVID-19 conjunctivitis. A case report

A clinical case of viral conjunctivitis COVID-19, which was complicated by partial symblepharon and severe dry eye syndrome, is presented. The latter was treated for several days with eye drops containing solutions of glucocorticosteroid, a cytostatic and an antiseptic combined with tear replacement therapy, which however led to an extensive detachment of the corneal epithelium of the right eye, a superficial ulcer and an area of keratomalacia in the lower part of the cornea. In view of this, a further hospital treatment was required: the patient received anti-inflammatory and keratoprotective drugs. A subsequent medical consultation found out that the patient had periodically instilled oxybuprocaine hydrochloride 0.4% into the right eye for pain relief for a long time (4 months) without informing the attending physician. As a result of hospital treatment, the condition of the patient’s right eye improved: the corneal ulcer, was epithelialized, followed by the formation of a vascularized corneal leukoma. In our opinion, a deterioration of the tear film stability of the patient, who had had COVID-19 accompanied by ocular manifestations in the form of initially developed conjunctivitis, was due to the anesthetic effect of long-term instillations of oxybuprocaine hydrochloride. This led to a significant decrease in tear secretion, a decrease in the density of goblet cells of the conjunctiva and a violation of the sensory innervation of the cornea, which gradually brought about a severe dry eye syndrome. The above case clearly demonstrates the importance of increasing the patients’ awareness of the harm that could be caused by long-term use of local anesthetics without a doctor’s approval.