Corneal Deposits After Topical Tosufloxacin in a Patient With Poor Tear Secretion

Abstract

To report on severe visual impairment in a patient with decreased tear secretion in whom dense corneal deposits resulted from tosufloxacin treatment after cataract surgery. An 86-year-old woman complained of blurred vision in the left eye. She had been treated with topical applications of tosufloxacin, betamethasone, and diclofenac sodium, all administered 4 times a day as a regimen lasting for 1 month after cataract surgery. In that eye, the best spectacle-corrected visual acuity was 20/200 due to the dense deposits on the cornea. The Schirmer test showed a decrease in basic tear secretion (right eye 2 mm, left eye 1 mm). We removed these deposits surgically and analyzed them by infrared spectrophotometry. The best spectacle-corrected visual acuity markedly improved, to 20/25, after surgical removal of the deposits in the left eye. The spectrophotometric pattern of the deposits was consistent with that of tosufloxacin. Topical application of tosufloxacin may lead to fluoroquinolone drug deposition on the cornea, especially when an antibiotic drug has been used continuously in patients with poor tear secretion.