What topical anesthetic is recommended for a patient with mild pain in one corner of the eye after a foreign body (grain of sand) incident with no redness or swelling for a week?

From the Guidelines

For persistent mild eye pain after a foreign body incident with no redness or swelling for a week, I would not recommend using any topical anesthetic. Over-the-counter artificial tears would be more appropriate for comfort. Prescription topical anesthetics like proparacaine or tetracaine, as mentioned in the study 1, are not recommended for home use as they can delay healing, mask worsening symptoms, and potentially damage the corneal epithelium with prolonged use. Some key points to consider in this scenario include:

• The patient's symptoms have persisted for a week without visible inflammation, suggesting the foreign body may have caused a corneal abrasion that needs proper evaluation.
• The use of topical anesthetics, such as proparacaine or tetracaine, is generally recommended for procedures like ocular hygiene to remove inflammatory debris and break down conjunctival adhesions, as stated in the study 1.
• However, in the context of a patient's home use for mild pain after a foreign body incident, the risks associated with topical anesthetics, such as delaying healing and masking symptoms, outweigh the benefits. The patient should see an eye care professional promptly for examination with fluorescein staining to identify any corneal damage, as the continued pain could indicate retained material or infection requiring professional treatment rather than self-administered anesthetics.

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; it is also indicated for use as a topical anesthetic prior to surgical operations such as cataract extraction. Tetracaine Hydrochloride Ophthalmic Solution 0.5% is indicated for procedures requiring a rapid and short-acting topical ophthalmic anesthetic.

For a patient with mild pain in one corner of the eye after a foreign body (grain of sand) incident with no redness or swelling for a week, proparacaine 2 would be a good topical anesthetic option. This is because it is indicated for procedures such as removal of foreign bodies from the cornea, which aligns with the patient's condition. Tetracaine 3 is also a topical anesthetic, but its indication is more general for procedures requiring rapid and short-acting anesthesia, without specific mention of foreign body removal.

From the Research

Topical Anesthetics for Eye Pain

• For a patient with mild pain in one corner of the eye after a foreign body incident with no redness or swelling for a week, a topical anesthetic may be considered to alleviate the pain.
• According to a study published in 2014 4, topical proparacaine 0.5% was found to be more effective in preventing pain during intravitreal injections compared to levobupivacaine 0.75%.
• Another study from 2007 5 lists proparacaine as one of the commonly used topical ocular anesthetics, but notes that all these drugs can be toxic, particularly when abused.
• Tetracaine is also a commonly used topical anesthetic, and a study from 2014 6 found that topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions.
• A review of topical anesthesia from 2015 7 lists various topical anesthetic agents available for use, including proparacaine, tetracaine, and lidocaine, and notes that careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients, and possible side-effects.
• However, it is also important to note that topical anesthetic abuse can lead to serious complications, including corneal superinfection with Candida, as reported in a study from 1996 8.

Recommended Topical Anesthetics

• Based on the available evidence, proparacaine 0.5% or tetracaine 1% may be considered as a topical anesthetic for a patient with mild pain in one corner of the eye after a foreign body incident.
• However, it is essential to use these medications judiciously and under the guidance of a healthcare professional to minimize the risk of adverse effects and complications.