Recommended Frequency of Use for Tetracaine Ophthalmic Drops
Tetracaine ophthalmic drops should be used as single drops applied topically to the eye(s) only as needed for procedures requiring a rapid and short-acting topical ophthalmic anesthetic, and should not be prescribed for patient self-administration. 1
Administration Guidelines
- Tetracaine ophthalmic solution 0.5% is indicated for procedures requiring a rapid and short-acting topical ophthalmic anesthetic and should be administered as one drop topically in the eye(s) as needed 1
- The unused portion should be discarded after each use to prevent contamination and potential toxicity 1
- Tetracaine ophthalmic solution is NOT intended for patient self-administration and should only be administered by healthcare providers 1
Safety Considerations
- Prolonged use or abuse of tetracaine drops may lead to corneal epithelial toxicity and can manifest as epithelial defects which may progress to permanent corneal damage 1
- Patients should not touch the eye for at least 10-20 minutes after using tetracaine as accidental injuries can occur due to insensitivity of the eye 1
- Tetracaine is significantly more toxic to corneal epithelial cells than other topical anesthetics like proparacaine (approximately four times more toxic) 2
- Tetracaine should not be used intracamerally as it may damage corneal endothelial cells 1
Maximum Dosing Considerations
- For ophthalmic use, tetracaine has a maximum recommended dose of 1.5 mg/kg when used with epinephrine and 1 mg/kg without epinephrine 3
- The duration of action for tetracaine is approximately 180-600 minutes, which is significantly longer than many other local anesthetics 3
Special Populations
- Doses of ester local anesthetics like tetracaine should be carefully calculated based on patient weight to avoid toxicity 3
- Lower doses should be used in very vascular areas due to increased systemic absorption 4
- Enhanced sedative effects may occur when high doses of local anesthetics are combined with other sedatives or opioids 3
Clinical Evidence
- Despite concerns about toxicity with repeated use, a randomized clinical trial found that topical tetracaine used for 24 hours was safe for treatment of pain caused by corneal abrasions and did not affect corneal healing 5
- Patients rated tetracaine as significantly more effective than saline for pain relief (7.7 vs. 3.9 on a numeric rating scale) 5
- Unlike some other medications, buffering tetracaine hydrochloride actually increases the pain of its instillation, suggesting that pain with instillation is not dependent on low pH 6
Common Pitfalls to Avoid
- Prescribing tetracaine for patient self-administration (not FDA-approved for this use) 1
- Prolonged or repeated use leading to corneal epithelial damage 1, 2
- Failure to warn patients about not touching their eyes for 10-20 minutes after administration 1
- Using actual body weight instead of ideal body weight for dose calculations in obese patients 4