Safety and Effectiveness of Topical Anesthetics in Corneal Abrasions: Systematic Review and Meta-Analysis



      Topical anesthetics are used in the emergency department (ED) to relieve eye pain and allow eye examinations in patients with corneal abrasions. There is concern for delayed corneal healing, which is associated with the long-term use of topical anesthetics, so outpatient use is not recommended.


      We sought to systematically study the effectiveness and complications associated with the short-term use of topical anesthetics (≤72 hours) in the management of patients presenting to EDs with corneal abrasions.


      Four electronic databases were searched from inception of the database until April 2014. We included studies of patients >16 years of age who were using topical anesthetics for <72 hours. Postoperative cases were not included.


      A total of 140 patients (68 in the intervention group and 72 in the control group) from 2 randomized trials were included in the analysis. Comparing control patients who did not use topical anesthetics to study patients who did use topical anesthetics, this meta-analysis found no significant difference in pain scores (standardized mean difference −1.01 [95% confidence interval {CI} −2.39 to 0.38), corneal healing (OR 1.31 [95% CI 0.53–3.27), or persistent symptoms (OR 0.98 [95% CI 0.06–16.69). The 2 trials reported no adverse effects.


      There were no differences regarding pain, persistent symptoms, or corneal healing when comparing short-term use of topical anesthetics to placebo in the treatment of corneal abrasion. Data on safety are sparse, and the use of this treatment is currently not supported by evidence.


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        • Shields T.
        • Sloane P.D.
        A comparison of eye problems in primary care and ophthalmology practices.
        Fam Med. 1991; 23: 544-546
        • Le Sage N.
        • Verreault R.
        • Rochette L.
        Efficacy of eye patching for traumatic corneal abrasions: a controlled clinical trial.
        Ann Emerg Med. 2001; 38: 129-134
        • Knox K.A.
        • McIntee J.
        Nurse management of corneal abrasion.
        Br J Nurs. 1995; 4 (459–460): 440-442
        • Wipperman J.L.
        • Dorsch J.N.
        Evaluation and management of corneal abrasions.
        Am Fam Physician. 2013; 87: 114-120
        • Fraser S.
        Corneal abrasion.
        Clin Ophthalmol. 2010; 4: 387-390
        • Wong T.Y.
        • Lincoln A.
        • Tielsch J.M.
        • Baker S.P.
        The epidemiology of ocular injury in a major US automobile corporation.
        Eye. 1998; 12: 870-874
        • Calder L.
        • Balasubramanian S.
        • Stiell I.
        Lack of consensus on corneal abrasion management: results of a national survey.
        CJEM. 2004; 6: 402-407
        • Walker R.A.
        • Adhikari S.
        Eye emergencies.
        in: Tintinalli J.E. Stapczynski S. Cline D.M. Ma O.J. Cydulka R.K. Meckler G.D. Tintinalli's emergency medicine: a comprehensive study guide. 7th edn. McGraw-Hill, New York2011
        • Ufberg J.W.
        • Karras D.J.
        Dogma challenged: tetracaine for corneal abrasions?.
        Acad Emerg Med. 2014; 21: 467-468
        • Verma S.
        • Corbett M.C.
        • Marshall J.
        A prospective, randomized, double-masked trial to evaluate the role of topical anesthetics in controlling pain after photorefractive keratectomy.
        Ophthalmology. 1995; 102: 1918-1924
        • Verma S.
        • Corbett M.C.
        • Patmore A.
        • Heacock G.
        • Marshall J.
        A comparative study of the duration and efficacy of tetracaine 1% and bupivacaine 0.75% in controlling pain following photorefractive keratectomy (PRK).
        Eur J Ophthalmol. 1997; 7: 327-333
        • Waldman N.
        • Densie I.K.
        • 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: 374-382
        • Ting J.Y.
        • Barns K.J.
        • Holmes J.L.
        Management of Ocular Trauma in Emergency (MOTE) trial: a pilot randomized double-blinded trial comparing topical amethocaine with saline in the outpatient management of corneal trauma.
        J Emerg Trauma Shock. 2009; 2: 10-14
        • Ball I.M.
        • Seabrook J.
        • Desai N.
        • Allen L.
        • Anderson S.
        Dilute proparacaine for the management of acute corneal injuries in the emergency department.
        CJEM. 2010; 12: 389-394
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Open Med. 2009; 3: e123-e130
        • Higgins J.P.
        • Altman D.G.
        • Gotzsche P.C.
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
      1. Higgins J.P.T. Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011 (Available from
        • Dua H.S.
        • Forrester J.V.
        Clinical patterns of corneal epithelial wound healing.
        Am J Ophthalmol. 1987; 104: 481-489
        • Willis W.E.
        • Laibson P.R.
        Corneal complications of topical anesthetic abuse.
        Can J Ophthalmol. 1970; 5: 239-243
        • Moller H.U.
        • Ahrendt N.
        Corneal erosions aggravated by local anesthetic eye-drops.
        Ugeskr Laeger. 1983; 145 ([in Danish]): 173-174
        • Sheldon G.M.
        Misuse of corneal anesthetics.
        Can Med Assoc J. 1971; 104: 528
        • Wilson S.A.
        • Last A.
        Management of corneal abrasions.
        Am Fam Physician. 2004; 70: 123-128
        • Sharma R.
        • Brunette D.D.
        in: Marx J.A. Hockberger R.S. Walls R.M. Rosen's emergency medicine: concepts and clinical practice. 7th edn. McGraw-Hill, New York2011
        • Stern G.A.
        Pseudomonas keratitis and contact lens wear: the lens/eye is at fault.
        Cornea. 1990; 9: S36-S40
        • Upadhyay M.P.
        • Karmacharya P.C.
        • Koirala S.
        • et al.
        The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal.
        Br J Ophthalmol. 2001; 85: 388-392
        • Boberg-Ans G.
        • Nissen K.R.
        Comparison of Fucithalmic viscous eye drops and Chloramphenicol eye ointment as a single treatment in corneal abrasion.
        Acta Ophthalmol Scand. 1998; 76: 108-111
        • Mukherjee P.
        • Sivarkumar A.
        Tetanus prophylaxis in superficial corneal abrasions.
        Emerg Med J. 2003; 20: 62-64
        • Calder L.A.
        • Balasubramanian S.
        • Fergusson D.
        Topical nonsteroidal anti-inflammatory drugs for corneal abrasions: meta-analysis of randomized trials.
        Acad Emerg Med. 2005; 12: 467-473
        • Turner A.
        • Rabiu M.
        Patching for corneal abrasion.
        Cochrane Database Syst Rev. 2006; 19: CD004764
        • Carley F.
        • Carley S.
        Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Mydriatics in corneal abrasion.
        Emerg Med J. 2001; 18: 273
        • Weissman B.A.
        Care of the contact lens patient: reference guide for clinicians.
        American Optometric Association, St. Louis2000

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