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Bromfenac-induced neurotrophic keratitis in a corneal graft
  1. Nimmy Raj,
  2. Arnav Panigrahi,
  3. Mahboob Alam and
  4. Noopur Gupta
  1. Cornea, Cataract and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Noopur Gupta; noopurgupta{at}


A man in his 30s, with a history of two operated penetrating keratoplasty (PK), primarily for viral keratitis, presented with pain, redness and diminution of vision in his left eye of 4 days duration. Postoperatively, he was prescribed oral antivirals, topical steroid eyedrops, lubricants and antiglaucoma medications. Eight months after transplantation, an epithelial defect with heaped up margins was noted on anterior segment evaluation on a routine follow-up visit. On checking his medications, it was found that the patient was unknowingly using bromfenac drops in place of brimonidine tartrate for the past month. A diagnosis of neurotrophic keratitis was made in the setting of PK performed for viral keratitis, incited by use of topical bromfenac. The patient was prescribed preservative-free lubricants with immediate discontinuation of bromfenac drops. Topical steroid drops were withheld till the epithelial defect healed. Complete healing of the defect was noted after 4 weeks of therapy.

  • Eye
  • Drug therapy related to surgery
  • General guidance on prescribing
  • Unwanted effects / adverse reactions
  • Transplantation

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  • Contributors NR, AP, MA, NG: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; NR, AP, MA, NG: drafting the work or revising it critically for important intellectual content; NR, AP, MA, NG: final approval of the version to be published; NR, AP, MA, NG: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.