Tetracaine for the win!
Use of tetracaine for simple corneal abrasion (see the definition*) appeared to be safe, with no serious adverse outcomes in 459 patients in this retrospective study. This is one of the largest studies to date and has an encouragingly tight 95% CI (upper 95% CI was 0.8%). But it was retrospective, and patients could have had serious complications and followed up elsewhere, which would have been missed. Interestingly, there are a growing number of small studies that have found topical anesthetics to be safe for corneal abrasion.
This study found 1% tetracaine for 24 hours appeared to be safe for treating corneal abrasion pain. REBEL EM has an outstanding post, a mythbusters type, which includes this study. It’s a great read.
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. Ann Emerg Med. 2017 May 2. pii: S0196-0644(17)30195-6. doi: 10.1016/j.annemergmed.2017.02.016. [Epub ahead of print]
*Simple corneal abrasion was, “defined as a corneal abrasion (fluorescein uptake on the cornea) that was not large (size subjectively determined by the physician), penetrating, or lacerating. It should have occurred within the past 2 days and be due to a simple traumatic cause, not from chemicals, contact lens use, thermal burns (other than ultraviolet flash burns), contaminated wounds, or infection. It should not have a retained foreign body such as a rust ring after removal in the ED, nor be in a patient younger than 15 years, and should not require the immediate attention of an ophthalmologist.”