From the Guidelines
Topical tetracaine is not recommended for near-eye lacerations due to potential risks of corneal epithelial toxicity and delayed wound healing. The provided evidence does not specifically address the use of topical tetracaine for near-eye lacerations, but it does discuss the use of lidocaine, epinephrine, and tetracaine (LET) for simple lacerations 1. However, the guidelines for LET use do not include near-eye lacerations, and the potential risks associated with tetracaine use in this area outweigh any potential benefits.
Key considerations for managing near-eye lacerations include:
- Gentle cleaning and appropriate closure techniques if needed
- Systemic pain management with oral analgesics like acetaminophen or ibuprofen
- Evaluation by an ophthalmologist or oculoplastic specialist for lacerations close to the eye, especially those involving the eyelid margins or lacrimal apparatus
- Monitoring for signs of infection, visual changes, or eye pain, which would warrant immediate medical attention. If anesthesia is required during the initial treatment of periocular lacerations, lidocaine infiltration (1% or 2%) is typically preferred 1.
From the Research
Topical Tetracaine for Near Eye Lacerations
- The use of topical tetracaine for near eye lacerations has been studied in various clinical trials 2, 3, 4, 5, 6.
- A study published in 2007 discussed the toxicities of topical ophthalmic anesthetics, including tetracaine, and noted that while generally well tolerated, these drugs can be toxic, particularly when abused 2.
- A 2014 study found that topical tetracaine used for 24 hours is safe and effective for the treatment of pain caused by corneal abrasions, with no significant difference in corneal healing between the tetracaine and saline groups 3.
- Another study published in 1998 found that the use of a topical lidocaine, epinephrine, and tetracaine solution provided sufficient anesthesia for laceration repair, with significantly fewer patients requiring injectable anesthetic 4.
- A 1998 study compared the effectiveness of tetracaine-lidocaine-phenylephrine topical anesthesia with lidocaine infiltration during repair of mucous membrane lacerations in children, and found that lidocaine infiltration performed better than topical anesthesia 5.
- A 2018 observational study found that routinely sending patients home with a 24-hour supply of topical tetracaine from the emergency department for simple corneal abrasion pain is potentially safe, with no serious complications or uncommon adverse events attributed to tetracaine 6.
Safety and Efficacy
- The safety and efficacy of topical tetracaine for near eye lacerations have been demonstrated in several studies 3, 4, 6.
- However, the potential for toxicity and abuse of topical anesthetics, including tetracaine, should be considered 2.
- The use of topical tetracaine may be associated with increased risks of ED recheck and fluorescein staining, particularly in patients with non-simple corneal abrasions 6.
Clinical Use
- Topical tetracaine may be considered for use in patients with near eye lacerations, particularly for the treatment of pain caused by corneal abrasions 3, 6.
- However, the decision to use topical tetracaine should be made on a case-by-case basis, taking into account the individual patient's needs and medical history 4, 5.