Is it acceptable to administer fluorescein (fluorescein) eye drops and tetracaine (tetracaine) eye drops to a 13-year-old patient for an eye examination?

From the Guidelines

Fluorescein and tetracaine eye drops can be safely administered to a 13-year-old during an eye examination when performed by a qualified eye care professional. According to the most recent guidelines from the Pediatrics journal 1, local anesthetic agents like tetracaine are considered safe when used appropriately. The maximum recommended dose of tetracaine is 1.5 mg/kg with epinephrine, and it is essential to calculate the maximum allowable safe dosage before administration to avoid excessive dosing.

Key Considerations

• Fluorescein is a harmless orange dye that helps detect corneal abrasions or foreign bodies.
• Tetracaine is a local anesthetic that temporarily numbs the eye surface to reduce discomfort during the examination.
• These medications are routinely used in pediatric eye exams and have established safety profiles when properly administered.
• The drops are typically used in small quantities and have minimal systemic absorption.

Administration and Monitoring

• These medications should only be administered by licensed eye care professionals such as ophthalmologists or optometrists in a clinical setting, not by parents or caregivers at home.
• The professional will determine the appropriate dosage based on the specific examination needs.
• After the exam, the child may experience temporary effects like mild stinging, blurred vision, or light sensitivity, which typically resolve within 30 minutes to a few hours.
• If unusual symptoms persist, follow-up with the eye care provider is recommended, as stated in the guidelines 1.

Safety Precautions

• It is crucial to follow the recommended dosages and guidelines to minimize the risk of adverse effects.
• The guidelines emphasize the importance of proper training and equipment for personnel administering sedation or local anesthetic agents, including the ability to rescue a child with apnea, laryngospasm, and/or airway obstruction 1.

By prioritizing the safety and well-being of the patient, fluorescein and tetracaine eye drops can be a valuable tool in pediatric eye exams, allowing for accurate diagnoses and effective treatment plans.

From the FDA Drug Label

8.4 Pediatric Use Safety in the pediatric population has been demonstrated in clinical trials. Efficacy of tetracaine hydrochloride ophthalmic solution for use in pediatric patients has been extrapolated from adequate and well controlled clinical trials in the adult population.

It is ok to provide a 13-year-old with tetracaine eye drops for an eye exam, as safety in the pediatric population has been demonstrated in clinical trials 2. However, it is essential to follow the instructions and precautions outlined in the drug label to minimize potential risks, such as corneal toxicity and insensitivity. Fluorescein eye drops are not mentioned in the provided drug label, so their use should be evaluated separately.

From the Research

Safety of Fluorosceine and Tetracaine Eye Drops for 13-Year-Olds

• The safety of providing fluorosceine and tetracaine eye drops to a 13-year-old for an eye exam is a concern due to potential toxicity and side effects.
• According to a study published in 1994 3, tetracaine was found to be approximately four times more toxic than proparacaine in vitro, although proparacaine and tetracaine have the same anesthetic potency in vivo.
• Another study from 2018 4 found that proparacaine 0.375%-sodium fluorescein 0.25% eye drop mixture led to a temporary change in central corneal thickness (CCT) and corneal volume (CV) of the anterior segment parameters.
• A 2024 study 5 compared the onset and duration of action of proparacaine, tetracaine, and oxybuprocaine, and found that tetracaine demonstrated the longest duration of action despite causing more discomfort.
• A 1994 study 6 compared proparacaine and tetracaine eye anesthetics and found that proparacaine caused less pain than tetracaine upon instillation and lasted slightly longer.
• A 2011 study 7 found that a combination of proparacaine 0.50%-sodium fluorescein 0.25% and ultrasound pachymetry caused a small but significant amount of corneal swelling.

Considerations for Use in Minors

• There is limited research on the specific use of fluorosceine and tetracaine eye drops in 13-year-olds.
• However, the available studies suggest that proparacaine may be a safer alternative to tetracaine due to its lower toxicity and faster onset of action.
• It is essential to weigh the potential benefits and risks of using these eye drops in minors and to consider alternative methods for eye exams that may be less invasive or irritating.
• The decision to use fluorosceine and tetracaine eye drops in a 13-year-old should be made by a qualified healthcare professional, taking into account the individual's specific needs and medical history 3, 4, 5, 6, 7.