Epithelial defect, diffuse lamellar keratitis, and epithelial ingrowth following post-LASIK epithelial toxicity

J Cataract Refract Surg. 2002 Aug;28(8):1463-6. doi: 10.1016/s0886-3350(02)01236-1.


This case reports an association between 2 uncommon flap complications in 1 eye related to epithelial toxicity and subsequent epithelial defect secondary to prolonged intraoperative exposure to topical anesthesia. A patient had hyperopic laser in situ keratomileusis (LASIK) for the correction of +2.75 +1.75 x 70 in the left eye. Because of the patient's anxiety and movement, additional topical local anesthesia was used and the flap remained reflected for 5 minutes. Immediately postsurgery, a toxic appearance was noted in the epithelium of the LASIK flap; 24 hours later, a large central epithelial defect was identified. Three days post- LASIK, the epithelial defect had healed but diffuse lamellar keratitis was noted in the interface, particularly underlying the location of the original epithelial defect. Over 6 weeks, a self-limiting epithelial ingrowth developed in the inferior interface. Fourteen months post-LASIK, the uncorrected visual acuity was 6/9 with a residual refraction of +0.50 +0.50 x 90.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Epithelium, Corneal / pathology*
  • Humans
  • Hyperopia / physiopathology
  • Hyperopia / surgery
  • Keratitis / etiology*
  • Keratitis / pathology
  • Keratomileusis, Laser In Situ / adverse effects*
  • Male
  • Middle Aged
  • Surgical Flaps / adverse effects
  • Surgical Flaps / pathology
  • Time Factors
  • Visual Acuity