To report a case of toxic keratitis due to chronic use of sodium hyaluronate eyedrops.

A 74-year-old female visited our clinic with severe ocular pain and decreased vision in both eyes. She had received refractive surgeries in both eyes 10 years prior. She had been using sodium hyaluronate eyedrops for the treatment of dry eye symptoms for 10 years. Slit-lamp examination revealed inferior punctate erosions in the inferior part of the cornea in both eyes. With her history of chronic use of sodium hyaluronate and after ophthalmologic examination, we suspected keratitis medicamentosa due to sodium hyaluronate eyedrops. We discontinued the eyedrops she was using and prescribed autologous serum. One month later, ocular discomfort and decreased vision were improved and corneal erosions were decreased.

In the present case, toxic keratitis was assumed to be associated with the use of sodium hyaluronate eyedrops and corneal erosions improved after the eyedrops were discontinued. We suggest sodium hyaluronate eyedrops are potentially hazardous and recommend a regular follow-up should be performed by a qualified ophthalmologist.