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Tetracaine

A topical eye anesthetic is a topical anesthetic that is used to numb the surface of the eye. Examples of topical eye anesthetics are oxybuprocaine, tetracaine, alcaine, proxymetacaine and proparacaine. more...

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Some topical eye anesthetics are also used in otolaryngology, like for example oxybuprocaine.

Use of topical eye anesthetics in ophthalmology

Topical eye anesthetics are used in ophthalmology in order to numb the surface of the eye (the outermost layers of the cornea and conjunctiva) for the following purposes:

In order to perform a contact/applanation tonometry.
In order to perform a Schirmer's test (The Schirmer's test is sometimes used with a topical eye anesthetic, sometimes without. The use of a topical eye anesthetic might impede the reliability of the Schirmer's test and should be avoided if possible.).
In order to remove small foreign objects from the uppermost layer of the cornea or conjunctiva. The deeper and the larger a foreign object which should be removed lies within the cornea and the more complicated it is to remove it, the more drops of the topical eye anesthetic are necessary to be dropped onto the surface of the eye prior to the removal of the foreign object in order to numb the surface of the eye with enough intensity and duration.

Duration of topical eye anesthesia

The duration of topical eye anesthesia might depend on the type of the topical eye anesthetic and the amount of eye anesthetic being applied, but is usually about half an hour.

Topical eye anesthetics abuse

Topical eye anesthetics can cause irreversible corneal damage and even complete destruction of the cornea when excessively used (excessive use means several times a day during several days or even weeks).

Some patients who suffer from eye pain, which is often considerably strong neuropathic pain caused by the irritation of the nerves within the cornea and/or conjunctiva, unfortunately try to illegally obtain oxybuprocaine or other eye anesthetics (for example by stealing them at their ophthalmologist, by forging medical prescriptions or by trying to order it via an online pharmacy) and secretly use the substance to numb their eye pain, often ending up with irreversible corneal damage or even destruction (which is a vicious cycle and causes even much more pain). Often, such patients finally require corneal transplantation.

This behaviour of the patients could be easily prevented by correct and timely information about centrally acting substances that drastically reduce such eye pain (see next section). Unfortunately, ophthalmologists often do not inform their patients about the correct treatment of neuropathic eye pain.

Correct medical treatment of prolonged and chronic eye pain

In case of prolonged or chronic eye pain, especially neuropathic eye pain, it is highly advisable to use rather centrally acting substances like anticonvulsants (pregabalin, gabapentin and in more serious cases carbamazepine) or antidepressants (for example SSRIs or the tricyclic antidepressant amitriptyline) than a topical eye anesthetic because a topical eye anesthetic very quickly begins to damage the cornea if applied too often. Even very small amounts of an anticonvulsant and/or an antidepressant can almost completely stop eye pain and does not damage the eye at all.

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Transdermal Treatment of Pain
From International Journal of Pharmaceutical Compounding, 9/1/05

What types of drugs are found in transdermal preparations?

* Many doctors choose to combine two or more types of medications in the transdermal preparation.

* Adjunct pain relievers: These medications are not anesthetics but reduce pain by blocking transmission of a pain signal to the brain. These include antidepressants such as amitriptyline and many other types of drugs.

* Anesthetics: Anesthetics relieve pain, and when used transdermally can be applied directly to a specific problem area. The most commonly used transdermal pain relievers are benzocaine, lidocaine, and tetracaine.

* Muscle relaxants: A muscle relaxant reduces the contractility of the muscle by blocking the transmission of nerve impulses. Common prescription examples include carisoprodol and cyclobenzaprine.

* Nonsteroidal anti-inflammatory drugs (NSAIDs): While NSAIDs act quickly and can relieve mild pain, their real therapeutic purpose is to minimize inflammation (swelling, redness) in the joints and tissues, which can affect movement in some cases. Examples of common NSAIDs are aspirin and ibuprofen.

Which specific ingredients are used?

Compounding pharmacists have far more options than commercial medicines provide, since commercial medicines are available only in fixed doses and in certain forms. (Many pain medications are available commercially only in oral form.) Transdermal pain formulations can include a number of drugs, including but not limited to those listed here. Some of these can be taken in oral form, but transdermal preparations usually cause fewer, if any, unwanted side effects.

* Amitriptyline

* Cyclobenzaprine

* Dexamethasone

* Gabapentin

* Ketamine

* Ketoprofen

* Lidocaine

* Piroxicam

What conditions are transdermal medications used for?

While there are many specific diagnoses for which transdermal pain medication may be ideal, the following are some of the most common:

* Arthritis

* Localized or acute injury

* Muscle and joint pain

* Nerve pain

Am I a candidate for transdermal pain medication?

Transdermal [trans = through; dermal = the skin] preparations are suitable for most people, and may be particularly useful in those who have an unusually sensitive digestive tract or difficulty swallowing. Transdermal pain medications may not be suitable for broken or raw skin or on very large surface areas. Patients who have allergies or sensitivities to any of the prescription components should not use these medications, and those who are allergic to soy may not be able to use preparations containing certain ingredients such as Pluronic lecithin organogel (PLO). As with any prescription, you should tell your Healthcare provider and pharmacist about all other prescription and overthe-counter medications and supplements you use so that they can screen for possible drug interactions. Talk to your doctor if you are pregnant or nursing a baby. Your pharmacist will advise you about possible side effects.

How are transdermal pain medications usually applied?

Your Healthcare provider will advise you how to apply the medication and for how long. This type of treatment typically is applied in the amount prescribed to the affected area(s) up to three times daily and rubbed in well. Some patients may gradually taper the amount they use as pain lessens. Application of a thin film onto clean, diy skin is generally all that is required to produce the needed effect.

How are transdermal medications dispensed?

Dispensing and packaging vaiy from pharmacy to pharmacy. The medication may come in a tube, a jar, or a syringe. In some cases, a jar with a special adapter is used, and a syringe will be dispensed along with it for easy application. Be sure to ask your pharmacist for a demonstration of how to measure your dose.

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