This is EM Cases Journal Jam Podcast 6 – Outpatient Topical Anesthetics for Corneal Abrasions.
I’ve been told countless times by ophthalmologists and other colleagues NEVER to prescribe topical anesthetics for corneal abrasion patients, with the reason being largely theoretical – that tetracaine and the like will inhibit re-epithelialization and therefore delay epithelial healing as well as decrease corneal sensation, resulting in corneal ulcers. With prolonged use of outpatient topical anesthetics for corneal abrasions, corneal opacification could develop leading to decreased vision.
Now this might be true for the tetracaine abuser who pours the stuff in their eye for weeks on end, but when we look at the literature for toxic effects of using topical anesthetics in the short term, there is no evidence for any clinically important detrimental outcomes. Should we ignore the dogma and use tetracaine anyway? Is there evidence that the use of topical anesthetics after corneal abrasions is safe and effective for pain control without adverse effects or delayed epithelial healing?
To discuss the paper “The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review” by Drs. Swaminathan, Otterness, Milne and Rezaie published in the Journal of Emergency Medicine in 2015, we have EM Cases’ Justin Morgenstern, a Toronto-based EM Doc, EBM enthusiast as well as the brains behind the First10EM blog interview Salim Rezaie, Clinical Assistant Professor of EM and Internal Medicine at University of Texas Health Science Center at San Antonio as well as the Creator & Founder of the R.E.B.E.L. EM blog and REBELCast podcast.
In this Journal Jam podcast, Dr. Morgenstern and Dr. Rezaie also discuss a simple approach to critically appraising a systematic review article, how to handle consultants who might not be aware of the literature and/or give you a hard time about your decisions and much more…
Published by Anton Helman, March 2016
References for Podcast on Outpatient Topical Anesthetics for Corneal Abraisons
Swaminathan A, Otterness K, Milne K, Rezaie S. The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review. J Emerg Med. 2015;49(5):810-5. Abstract
Puls HA, Cabrera D, Murad MH, Erwin PJ, Bellolio MF. Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis. J Emerg Med. 2015;49(5):816-24. Absract
Ball IM, Seabrook J, Desai N, Allen L, Anderson S. Dilute proparacaine for the management of acute corneal injuries in the emergency department. CJEM. 2010;12(5):389-96. Full PDF
Waldman N, Densie IK, Herbison P. 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. Acad Emerg Med. 2014;21(4):374-82. Abstract
Calder LA, et al. Topical Nonsteroidal Anti-Inflammatory Drugs for Corneal Abrasions: Meta-analysis of Randomized Trials. Academic Emergency Medicine 12(5) 2005. Full PDF
More FOAMed Resources on Outpatient Topical Anesthetics for Corneal Abraisons
Journal Club blog – ‘Should we use tetracaine for corneal abraisons?’ on SOCMOB
Deep dive critical appraisal of the Swaminathan paper on The SGEM
FOAMed Resources on Critical Appraisal of Systematic Review
Centre for Evidene-Based Medicine critical appraisal tools
A Review of Systematic Reviews on CanadiEM
BEEM critical appraisal tools on The SGEM
Dr. Helman, Dr. Rezaie, Dr. Morgenstern and Dr. Chan have no conflicts of interest to declare