Topical ophthalmic anesthetics for corneal abrasions

Proparacaine Overuse in Corneal Abrasions at the Emergency Department: A Case Series

“…Topical anesthetic drops are generally safe when administered in a controlled clinical setting, but when misused have the potential to cause complications including persistent epithelial defects, infectious keratitis, scarring, corneal melt, and corneal perforation. 3,4 The rapid onset and short duration (20-30 min) of ester-type anesthetic drops such as proparacaine 3 also potentiate abuse and addiction.…”

“…Currently there is insufficient evidence to establish the safety of topical anesthetics in the routine use in managing corneal abrasions, with plenty of evidence that detail their potential harms. 3 Alternatives to topical anesthetics for pain management include ointments (such as erythromycin) and bandage contact lenses to reduce friction on the corneal surface, cycloplegics to relieve pain from photophobia, and oral nonsteroidal anti-inflammatory drugs. 2 Although there is potential for the safe usage of topical anesthetics in corneal abrasions, this would necessitate prescribing only enough drops for 24 hr, strict adherence to discharge instructions including dosage and frequency, reliable follow-up with ophthalmology, and appropriate patient counseling.…”

“…However, the safe use of topical anesthetics for pain caused by corneal abrasions is unclear because of the paucity of sufficiently powered studies that establish a direct relationship between topical anesthetic use and complication rates. 3 The following three cases demonstrate potential dangers of unsupervised topical anesthetic use. In each case, a patient with a corneal abrasion was discharged from the ED with a 15-mL bottle of 0.05% proparacaine hydrochloride ophthalmic solution.…”

Cochrane corner: topical anaesthetics for pain control following corneal abrasions

“…By contrast, surveys of eyecare professionals conducted in the USA reported almost universal opposition to this practice [9,10]. The publication of the Cochrane Review by Sulewski et al on 'Topical ophthalmic anaesthetics for corneal abrasions' is, therefore, very timely [11].…”