From the Guidelines
Proparacaine (0.5%) or tetracaine (0.5%) eye drops are the recommended topical anesthetics for eye examinations, as they provide effective and temporary pain relief. According to the guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 1, the application of a topical local anesthetic, such as proparacaine or tetracaine, is necessary prior to ocular procedures.
Key Points to Consider
- The anesthetic effect of proparacaine or tetracaine begins within 20 seconds and lasts for about 15-20 minutes 1.
- Patients should be advised not to rub their eyes while the anesthetic is active, as this could lead to corneal damage since the protective pain response is temporarily disabled.
- The medication may cause brief stinging upon application and slight blurring of vision, but these effects are temporary and resolve quickly.
- Topical anesthetics are not prescribed for home use due to the risk of corneal damage with repeated application.
Administration and Dosage
- One or two drops of proparacaine (0.5%) or tetracaine (0.5%) are typically placed in the eye about 1-2 minutes before the examination 1.
- For routine eye exams, a single application is usually sufficient.
Important Considerations
- The use of topical anesthetic prior to the cycloplegic agent reduces the stinging and promotes penetration of subsequent eyedrops 1.
- Patients can resume normal activities immediately after the exam, though they should avoid driving until any pupil dilation (if performed) has worn off.
From the FDA Drug Label
Proparacaine hydrochloride ophthalmic solution is indicated for topical anesthesia in ophthalmic practice. Representative ophthalmic procedures in which the preparation provides good local anesthesia include measurement of intraocular pressure (tonometry), removal of foreign bodies and sutures from the cornea, conjunctival scraping in diagnosis and gonioscopic examination; Tetracaine Hydrochloride Ophthalmic Solution 0.5% is indicated for procedures requiring a rapid and short-acting topical ophthalmic anesthetic.
Topical anesthetics for eye exams include:
- Proparacaine 2 2
- Tetracaine 3 These can be used for procedures such as tonometry, removal of foreign bodies, and gonioscopic examination.
From the Research
Topical Anaesthetics for Eye Exams
- The most commonly used topical anaesthetics for eye exams are proparacaine, tetracaine, benoxinate (oxybuprocaine), cocaine, and lidocaine 4.
- These anaesthetics are generally well tolerated, but can be toxic, particularly when abused, and may cause ocular surface toxicity, deep corneal infiltrates, ulceration, and even perforation 4.
Comparison of Topical Anaesthetics
- A study comparing proparacaine, tetracaine, and oxybuprocaine found that proparacaine had the fastest onset of action, while tetracaine had the longest duration of action, but caused more discomfort 5.
- Another study compared topical proparacaine drops, 4% lidocaine solution, and 3.5% lidocaine gel for intravitreal injections, and found that proparacaine drops provided effective and cost-effective anesthesia 6.
- A study on chloroprocaine 3% gel as a novel ocular topical anaesthetic found it to be safe and effective, with a higher success rate compared to tetracaine 0.5% eye drops 7.
- A comparative study on replacing lidocaine gel with topical proparacaine anaesthesia for routine intravitreal injections found no statistical difference in pain scores between the two groups 8.
Safety and Efficacy
- Topical anaesthetics can cause systemic side effects, particularly cocaine, which has a higher incidence of systemic side effects and high abuse potential 4.
- The use of topical anaesthetics can provide effective and safe anesthesia for eye exams, but prolonged abuse can lead to serious complications 4.
- Chloroprocaine 3% gel has been shown to be a valid alternative in ocular topical anesthesia, with no treatment-emergent adverse events reported 7.