#EMConf: CAT Anesthetic eye drops
Question: Are anesthetic eye drops (proparacaine, tetracaine, etc.) for corneal abrasions effective for pain control AND safe to prescribe after discharge from the emergency department?
o Double blinded randomized controlled trial in Ontario, Canada
o 15 patients in treatment arm: diluted Proparacaine eye drops 0.05%
o 18 patients in placebo arm
o Use 2-4 drops as often as needed x7 days
o Document pain score and satisfaction score on 0-10 visual analog scale before and again 5 minutes after each drop
o All patients also given gatifloxacin antibiotic drops and Tylenol-Codeine tabs PRN
o All patients followed up with ophthalmologist on day 1, 3, and 5 to assess for delayed healing and complications
o Significant difference in pain reduction on 0-10 scale: 3.9 point reduction in Proparacaine group vs 0.6 point reduction in placebo group, p=0.007
o Significant difference in patient satisfaction on 0-10 scale: 8.0 in Proparacaine group vs 2.6 in Placebo group p 0.027
o Some patients excluded from analysis due to noncompliance with protocol
o No evidence of delayed corneal healing or other ocular complications in either group at ophthalmology follow up
o Double blinded randomized controlled trial in Invercargill, New Zealand
o 59 patients in treatment arm: Tetracaine 1%
o 57 patients in placebo arm (Saline)
o Use drops up to every 30 minutes as needed for pain in first 24 hour after discharge
o All patients also given chloramphenicol antibiotic drops and paracetamol at scheduled doses
o Document pain score on 0-100 visual analog scale every 30 minutes in first 2 hours after ED visit then every 2 hours for next 48 hours
o Follow up in ED at 48 hours and/or follow up phone call at one week and again at one month
o Asked about perceived effectiveness on 0-10 scale at one week follow up phone call
o 23 patients total (similar # from each group) excluded from analysis for persistent rust rings at 48 hour follow up
o No significant difference in fluorescein uptake at 48 hours, persistent symptoms at 48 hours, nor persistent symptoms at one week between two groups
o Zero complications at one month follow up
o No significant difference in pain reduction between two groups on 0-100 visual analog scale at either 24 or 48 hours
o There was a significant difference in patient perceived effectiveness on 0-10 scale at one week follow up phone call: 7.7 in tetracaine group vs 3.8 in saline group, p<0.0005
Conclusion: Based on these studies it appears to be safe and effective to prescribe a short course of topical anesthetic eye drops for patients with simple corneal abrasions after discharge from the ED.
Note this both of these studies provided patients with antibiotic drops
Consider if patient is reliable and follow up with ophthalmology
Ball, Ian Michael, et al. “Dilute Proparacaine for the Management of Acute Corneal Injuries in the Emergency Department.” Canadian Journal of Emergency Medicine, vol. 12, no. 05, Sept. 2010, pp. 389–394., doi:10.1017/s1481803500012537.
Waldman, Neil, et al. “Topical Tetracaine Used for 24 Hours Is Safe and Rated Highly Effective by Patients for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial.” Academic Emergency Medicine, vol. 21, no. 4, Apr. 2014, pp. 374–382., doi:10.1111/acem.12346.