Eye Care Professionals Advise Against Tetracaine for Managing Corneal Abrasions

Many eye care professionals do not support the use of a topical anesthetic (TA) for corneal abrasion pain management in the emergency department due to potential adverse events, according to a survey published in Eye & Contact Lens. While a majority of those surveyed reported their disapproval of its use in emergency settings and stated they would not prescribe it themselves, they were slightly more inclined to support TA use if they were the patient. 

“Physicians have a duty to adequately treat pain if the pain does not otherwise harm patients,” the study authors assert. “However, multiple case reports demonstrate the risk of permanent corneal damage and loss of vision in patients who use chronic TA drops, leading most eye care providers to avoid any repeated use of TAs except in the setting of performing an eye examination.”

Researchers included responses from 486 clinicians (ophthalmologists, 47.1%; optometrists, 52.9%) assessing attitudes towards the use of tetracaine for corneal abrasion pain management in the emergency department. The team administered a 3-question survey using a 5-point Likert scale (strongly disagree to strongly agree) and included responses received between November 2, 2020 and December 20, 2020. 

Eye care professionals expressed a strong disapproval of tetracaine use for all of the survey items — 97.7% reported disapproval with emergency department providers using the treatment, 96.9% stated they would not prescribe it for analgesia following corneal abrasions themselves, and 89% reported they would not use it if they were the patient.  

Clinicians who practiced for less than 10 years were less likely to show favorability towards prescribing tetracaine among emergency department providers (P =.007), and optometrists were less likely to prescribe TAs  compared with ophthalmologists when they performed the examination themselves (P=.039).

“Moving forward, having an evidence-based consensus from ophthalmologists, optometrists, and emergency medicine physicians on the best practices for managing corneal abrasions and associated pain would benefit patient care,” according to the researchers. “With the wide variation in the accepted care for corneal abrasions and the historic controversy surrounding the use of TAs, it would be beneficial to provide an evidence-based consensus on the management of corneal abrasions (. . .).”

Study limitations include the potential for response bias.