Tetracaine for Corneal Abrasions
“An Observational Study to Determine Whether Routinely Sending Patients Home With a 24-Hour Supply of Topical Tetracaine From the Emergency Department for Simple Corneal Abrasion Pain Is Potentially Safe”
Corneal abrasions caused by foreign bodies or trauma are a common complaint in the emergency department. Topical anesthetics like tetracaine drops, while useful in the initial ED evaluation of the injury and removal of the foreign body, have long been discouraged as an option for continued use by the patient due to safety concerns. This study attempts to further a growing body of evidence which indicates that topical anesthetic drops for pain control are indeed safe when used for a limited amount of time.
This is a single center, retrospective cohort study that took place in New Zealand from February 2014 to October 2015. In March of 2014 ED physicians at Southland Hospital began to adopt the routine prescription of 1.5mL (24 hour supply) 1% tetracaine drops for pain from simple corneal abrasions (SCA) in addition to the standard treatment. 1402 distinct patients with corneal injury were identified on chart review. Of those, 532 had SCA and 1054 were classified as having non simple corneal abrasions (NSCA). 303 patients with SCA received tetracaine along with the standard treatment and 229 patients received only the standard treatment. 141 patients with NSCA were given tetracaine inappropriately. Outcome measures were ED rechecks, persistent fluorescein uptake, ophthalmology clinic referrals, and complications.
Results: When considering all patients (SCA+NSCA) who received tetracaine drops the relative risk for ED rechecks and persistent fluorescein uptake was increased compared to those who received standard treatment (RR 1.67 and RR 1.65, respectively). However, when only considering those with SCA who received tetracaine there was no statistically significant difference in ED rechecks or fluorescein uptake compared to standard treatment. There were no serious complications or uncommon adverse events attributed to tetracaine.
The Takeaway: This study is yet another published in the last decade that shows that a limited supply of topical tetracaine for pain control for SCA is safe. However, this study does not tell us if topical tetracaine actually provides better pain control for SCA compared to standard treatment.