Tetracaine Eye Drops Research Articles

Comparing the sedative and analgesic effects of ketorolac and diclofenac eye drops among patients with cataract surgery: A double-blind randomized clinical trial

Abstract: AIM: The aim of this study was to compare the sedative and analgesic effects of ketorolac and diclofenac eye drops among patients with cataract surgery (CS) who received tetracaine. METHODS: This double-blind randomized clinical trial was conducted in 2022. Participants were the candidates for CS consecutively selected from Amirkabir hospital, Arak, Iran, and were assigned to an artificial tear group, a ketorolac group, and a diclofenac group through block randomization. Pain, sedation status, heart rate, blood pressure, and arterial oxygen saturation were assessed during and after surgery. Complications prevalence and intraoperative propofol use were also documented. Data were analyzed using the SPSS software (v. 20.0) at a significance level of <0.05. RESULTS: There were no significant differences among the study groups respecting participants’ age, gender, body mass index, blood pressure, heart rate, arterial oxygen saturation, CS duration, and Aldrete score (P > 0.05). From 5 min after CS onward, the mean score of pain in the ketorolac group was significantly less than the other groups (P < 0.05). The mean score of sedation from recovery to 1 h after surgery in the artificial tear group was significantly more than the other groups, whereas the mean score of sedation 2 and 4 h after CS in the ketorolac group was significantly more than the other groups (P < 0.05). Propofol use in the artificial tear group was significantly more than in other groups (P = 0.001) and patient and surgeon satisfaction in this group was significantly less than in other groups (P < 0.05). The ketorolac and the diclofenac groups did not significantly differ from each other respecting surgeon and patient satisfaction and the prevalence of complications (P > 0.05). CONCLUSION: Ketorolac eye drops are more effective than diclofenac eye drops in significantly reducing intraoperative pain among the candidates for CS with topical anesthesia. Therefore, ketorolac eye drops can be used with tetracaine eye drops in CS with topical anesthesia to produce greater perioperative analgesia and sedation.

Influence of Pre- and Intraoperative Local Anaesthetic in Strabismus Surgery under General Anaesthesia in Adults.

As studies have shown a reduction in the occurrence of the oculocardiac reflex with the addition of local anaesthesia, we changed our care regime accordingly a few years ago. To promote and establish better patient care, we retrospectively analysed the files of our patients who underwent strabismus surgery from 2013 to 2021 in order to compare strabismus surgery under general anaesthesia with and without local anaesthetics in a routine clinical setting. Data from 238 adult patients who had undergone strabismus surgery could be extracted from the files: G1: n = 102, only general anaesthesia; G2: n = 136, preoperative application of tetracaine eye drops and intraoperative subtenon lidocaine/levobupivacaine in addition to general anaesthesia. We compared the two groups in regard to the frequency of oculocardiac reflex, the amount of atropine needed to treat, as well as the amount of antiemetic and analgesic medication given, and time spent in the recovery room. Mean age of G1 was 50 years and 52 years in G2. There was no significant difference between the kind of surgeries (recessions/resections), the number of patients who had undergone a reoperation, or the duration of the operations. Adding local anaesthetics resulted in significantly less occurrence of oculocardiac reflex (p = 0.009), a reduction in the need for atropine, analgesic, or antiemetic medication, as well as reduced time in the recovery room. As this increases patient safety and comfort and is cost-effective (less time in the recovery room), we recommend adding perioperative local anaesthesia to strabismus surgery performed under general anaesthesia.

Topical Lidocaine Gel Versus Tetracaine Eye Drops for Panretinal Photo-coagulation in Proliferative Diabetic Retinopathy

Panretinal photocoagulation (PRP) is a treatment for proliferative diabetic retinopathy (PDR). The procedure needs anesthetic agent to overcome the pain. Two widely used anesthetic agents are used in this study which are tetracaine 0.5% eyedrops and lidocaine 2% gel. This study aimed to compare the effectivity and efficacy of both anesthetic agents. A prospective randomized controlled trial was done to 40 eyes divided into two groups, group A was treated with tetracaine 0.5% eyedrop and group B with lidocaine 2% gel. Pain score was obtained subjectively from the patient and recorded during four stages of procedure. The results showed that the mean age was 56.5 years in Group A and 53.20 years in group B. Average procedure duration was 8.7 minutes in group A and 9.35 minutes in group B. Average 5 minutes pain level was 3.05 and 2.10 in group A and B consecutively. Average 10 minutes pain level was 2.65 and 2.45 in group A and B consecutively. Average during procedure pain level was 2.70 and 3.40 in group A and Group B, and average post procedure pain level was 1.20 in Group A and 1.55 in Group B. There was no significant difference between both groups’ parameters. In conclusion, the use of both agents is interchangeable and shows no differences in efficacy and effectivity. Keywords: panretinal photocoagulation; proliferative diabetic retinopathy; anesthetic agent; tetracaine; lidocaine

Adverse Reactions from Topical Ophthalmic Anesthetic Abuse.

To assess the adverse drug reactions (ADR) of tetracaine among patients referred to an eye emergency department in the southeast of Iran. In this case series study, we assessed 31 eyes of 24 patients who were referred due to adverse effects of ocular anesthetics during2017-2020. We collected the data, including age, sex, job, how the medicine was obtained, symptoms, examination results, and ADR. Of 24 patients, 22 (91.7%) were male. The mean (standard deviation) age of the patients was 32.6 (1.9) years. Twenty-two patients obtained the medicines without a prescription and a general practitioner prescribed the medicine to two patients. In the first interview, the most common symptoms were: photophobia, reduced vision, ocular pain, and redness. The main signs of persistent epithelial defect, patchy or diffuse corneal stromal infiltration, ring infiltration, and Descemet's folds were noticed in the examinations. Finally, 51.6% (n =16) of the eyes had decreased vision, 45.2% (n =14) had corneal opacity, 16.1% (n = 5) had elevated intraocular pressure that needed long-term anti-glaucoma therapy, and 6.5% (n = 2) had corneal pannus. Corneal perforation and phthisis bulbi were the final results in one eye. ADR related to the use of ophthalmic topical anesthetics could cause sight-threatening severe morbidities. It seems that some general practitioners are not careful regarding the prescription of these kinds of medicine. Moreover, the over-the-counter availability of tetracaine eye drops should be managed.

The Effectiveness of 2% Lidocaine Gel Compared to 0.5% Tetracaine Eye Drop As Topical Anesthetic Agent for Phacoemulsification Surgery.

BackgroundTopical anesthetics have become the primary choice in phacoemulsification procedures for cataract extraction. The most common topical anesthetic drug used is 0.5% tetracaine eye drops. Repeated administration of 0.5% tetracaine drops can cause corneal epithelial damage. Two percent lidocaine gel is latest option which has longer contact time with corneal epithelium.ObjectivesTo compare the effectiveness of 2% lidocaine gel with 0.5% tetracaine drops in phacoemulsification surgery.MethodsThe study was a single blinded randomized clinical trial from March to July 2017 in patients underwent phacoemulsification cataract surgery. There were 72 subjects with age ≥ 40 years old who received randomization and divided into 2 groups: 2% lidocaine gel group and 0.5% tetracaine eye drop group. Topical anesthetics were applied 5 minutes before surgery. Five minutes after surgery, pain scale perceived during surgery was assessed by using a numerical rating scale. At the end of surgery, the subject filled the satisfaction questionnaire on topical anesthetic drugs administered. The ophthalmologists were also given a satisfactory questionnaire for topical anesthetic drugs selected for the procedure.ResultsThe median pain scale for 2% lidocaine gel group pain scale was 1; meanwhile, the median pain scale for 0.5% tetracaine eye drops was 3 (P < 0.05).ConclusionsTwo percent lidocaine gel was more effective in relieving pain during phacoemulsification cataract surgery compared with 0.5% tetracaine drops.

Topical Anesthetic Misuse in Patients Admitted to Sabzevar Eye Clinic in Iran

Abstract Topical anesthetic eye drops are used extensively for ophthalmic examinations but self-treatment and non-technical removal of foreign bodies using tetracaine drops can be hazardous. The present study intended to determine the inadmissible uses of anesthetic tetracaine eye drops, manner of drug obtaining and likelihood of the ocular complications in the patients. This cross-sectional study was conducted on 162 patients with ocular pain and foreign body sensation, red eye or lid edema admitted to the Eye clinic in Sabzevar, Iran. Variables included age, sex, chief compliant, job, site of foreign bodies, diagnosis of problem, use of tetracaine drops, drug provision, times patients referred to the eye clinic, and kinds of treatment. The most common chief complaint for admission to the Eye clinic was lacrimation (55.6%), followed by ocular pain, and foreign body sensation (35.8%). Some patients (30.9%) (mostly welders) inadmissibly used topical tetracaine eye drops; 21.6% of cases obtained tetracaine eye drops from drugstores without doctor’s prescription, and only 3.7% provided drugs by prescription. Corneal site (81.5%) was the most common location of foreign body; metallic foreign body (63%) was the most common. One patient was admitted in hospital for management. Topical inadmissible tetracaine (0.5%) is commonly used by welders, who obtain it from drugstores without prescriptions due to its simple usage and short acting pain relief. Supervision is required over drugstores for denying it if demanded without a prescription. Enhancing clients’ awareness is also suggested.

Pain assessment in premature infants treated with intravitreal antiangiogenic therapy for retinopathy of prematurity under topical anesthesia

To evaluate the physiological and behavioral pain response in premature infants receiving intravitreal bevacizumab injection (IVB) for retinopathy of prematurity (ROP) under topical anesthesia. A prospective interventional non-comparative case series. Premature infants with high-risk prethreshold or threshold ROP received IVB using topical anesthesia with tetracaine eye drops. A Premature Infant Pain Profile was used to assess the pain response during the procedure. Nine premature infants requiring bilateral IVB therapy were included in the study. Mean gestational age was 28.7 ± 1.3 weeks, and birth weight was 1,200 ± 194 grams. The mean total pain score was found to be 8.7 ± 2.4 (range 5-14), indicating generally mild pain during the procedure. Eye squeeze was the most prominent indicator of pain. Most changes occurred at the beginning, with the insertion of the lid speculum and were hardly noted during the rest of the procedure including the injection itself. Topical anesthesia with tetracaine is an effective method for the relief of pain associated with intravitreal injections in premature infants with ROP.

Comparative efficacy of topical tetracaine solution versus lidocaine gel in cataract surgery

Comparative efficacy of topical tetracaine solution versus lidocaine gel in cataract surgery Roberto Bellucci1, Francesco Bellucci21Ophthalmic Unit, Department of Neurosciences, Hospital and University of Verona, Verona, Italy; 2Faculty of Psychology, University of Parma, Parma, ItalyBackground: Cataract surgery is mainly performed under topical anesthesia achieved either by tetracaine solution (0.5%&ndash;1.0%) or gel (0.5%), or by 2% lidocaine gel. This paper reviews the current knowledge about these two drugs, with special emphasis on a published prospective comparison between them.Methods: The main pharmacological aspects of topical anesthetic agents are summarized, explaining the difference between the ester (tetracaine) and the amide (lidocaine) compounds. Tetracaine is available as single-use eye drops, or as a multidose gel containing benzalkonium chloride, a preservative not contained in the multidose lidocaine gel. A literature search was performed, using &ldquo;tetracaine&rdquo;, &ldquo;tetracaine gel&rdquo;, &ldquo;lidocaine&rdquo;, &ldquo;lidocaine gel&rdquo;, &ldquo;lidocaine jelly&rdquo;, and &ldquo;cataract surgery&rdquo; as keywords, and compiling cross-references. A total of 25 studies were identified and included in this review. Of them, seven were uncontrolled studies describing different experiences with the drugs of interest, and 18 were controlled studies. Six studies directly compared tetracaine eye drops or gel with lidocaine gel before cataract surgery.Results: Both tetracaine solution and gel and lidocaine gel proved to be effective in providing analgesia before cataract surgery. Both drugs were comparable with needle injection anesthesia when intracameral lidocaine was added to topical treatment. Direct comparisons indicate better activity for tetracaine when used at the 1% concentration in single-dose units, or in the gel form at a 0.5% concentration. Patients showed a slight preference for the agent that caused the least discomfort when administered (lidocaine), while the surgical complication rate and the surgeon satisfaction were the same with either drug.Conclusion: Tetracaine solution and lidocaine gel were equally effective in providing topical anesthesia for cataract surgery in the published studies. Tetracaine was found to be better than lidocaine only if augmented by either increasing the concentration to 1% (solution) or by increasing the penetration by adding benzalkonium chloride (gel).Keywords: tetracaine, tetracaine gel, lidocaine, lidocaine gel, cataract surgery

Anesthetic keratopathy presenting as bilateral Mooren-like ulcers

This observational case report describes the development of bilateral Mooren-like ulcers in a patient with anesthetic keratopathy. A 42-year-old man with a recent history of minor eye trauma and pain self-treated with tetracaine eye drops presented with complaints of acutely worsening vision and severe pain bilaterally. His visual acuity at presentation was limited to hand motion. Slit-lamp examination revealed bilateral epithelial defects at the center of the cornea, and an area of stromal infiltration and thinning with an undermining leading edge resembling a Mooren’s ulcer in both eyes. Corneal haze and hypopyon were visible. Anesthetic use was halted immediately and the patient was started on prednisolone and mycophenolate mofetil (Cellcept®), after which visual acuity gradually improved and pain decreased. Despite improvement of symptoms, residual epithelial defects remained, and the patient was ultimately treated with keratoplasty for recovery of vision. We suggest that anesthetic keratopathy should be included in the differential diagnosis for any patient presenting with ring-shaped stromal infiltrates or nonhealing epithelial defects.

Ophthalmic and anesthetic evaluation of topical 1% tetracaine and 0.5% proparacaine in dogs

The aim of this study was to establish the action of 1% tetracaine eye drops in combination with 0.1% phenylephrine in two different posologies and their effects on the eye compared to the 0.5% proparacaine drops in dogs. 22 animals were divided into two groups: TG (11 animals), received 1% tetracaine associated with 0.1% phenylephrine eye drops, one drop instilled in the left eye and two drops, with one-minute interval between each, instilled in the right eye; PG (11 animals) received 0.5% proparacaine eye drops following the same dosage. The average duration of the observed anesthetic action was 25 minutes for tetracaine and 15 minutes for proparacaine. The instillation of two drops increased anesthetic time in five minutes. No changes in intraocular pressure, pupil diameter and tear production was observed. The drops of tetracaine triggered chemosis in four (36.4%) animals. Topical anesthesia with proparacaine eye drops showed no adverse reactions and is thus recommended preferentially.

Nine-month results of intravitreal bevacizumab versus triamcinolone for the treatment of diffuse diabetic macular oedema: a retrospective analysis

To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME). This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline. After 1-, 3-, 6- and 9-month follow-up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group. In our study collective, neither IBe nor ITA treatment was able to improve VA during follow-up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline.

Effect of corneal epithelium on ultraviolet-A and riboflavin absorption

To determine if the corneal epithelium prevents the collagen cross-linking effect. Using immunofluorescence microscopy after CXL, we indirectly analyzed the role of the epithelium as ultraviolet-A (UVA) shield as well as a barrier to riboflavin penetration. Fifteen freshly enucleated porcine eyes were divided into 3 groups. The corneal epithelium was kept intact in all groups. Five eyes served as control (Group 1). On group 2, eyes received tetracaine anesthetic drops and topical 0.1% riboflavin solution (10 mg riboflavin-5-phosphate in 10 mL 20% dextran-T-500). On Group 3, riboflavin was injected into the anterior chamber to allow penetration of the drug through the endothelium. Groups 2 and 3 were exposed to UVA (365 nm, 3 mW/cm(2)) for 30 minutes. Ultra-thin sections (8 µm) of the corneas were stained with anti-collagen type I and DAPI (4,6-diamidino-2-fenilindole dihydrocloride) and analyzed with fluorescence microscopy. Corneas treated with UVA irradiation and intracameral injection of riboflavin (Group 3) showed greater pattern of collagen organization compared to groups 1 (Control) and 2 (riboflavin and tetracaine eye drops). A yellow stromal staining, which represents the riboflavin diffusion into the stroma, was only observed in eyes injected with riboflavin into the anterior chamber. Using immunofluorescence microscopy in porcine corneas, we demonstrated that the corneal epithelium reduces the effectiveness of CXL by preventing the penetration of the drug and not by limiting the UVA transmittance. An inadequate intrastromal concentration of riboflavin may impair CXL effect.

Tetracaine 0.5% eyedrops with or without lidocaine 2% gel in topical anesthesia for cataract surgery

To evaluate the level of pain during phacoemulsification and foldable intraocular lens implantation under instillation of tetracaine 0.5% eyedrops versus a combination of lidocaine 2% gel and instillation of tetracaine eyedrops. This prospective, randomized, controlled study included 51 patients undergoing phacoemulsification under topical anesthesia. They were randomized into two groups based on the topical anesthetic method they were to receive. Preoperatively all patients were asked to answer a questionnaire. One hour postoperatively, they were asked to grade their intraoperative and postoperative pain on a visual analog scale from 0 to 10. There were no statistically significant differences between the two methods of anesthesia. Gender and the presence of relatives or friends were independent factors playing a significant role in pain sensitivity. The combination of lidocaine 2% gel and tetracaine eyedrops does not have a better analgesic result than a single instillation of tetracaine 0.5% eyedrops.

Randomised controlled trial on the effectiveness of lidocaine gel vs tetracaine drops as the sole topical anaesthetic agent for primary pterygium surgery

To determine the effectiveness of lidocaine 2% gel vstetracaine 1% drops in primary pterygium surgery. This was a prospective, randomised controlled trial. Forty consecutive patients who had primary pterygium underwent surgical excision of primary pterygium and mitomycin C. Patients were randomised into two groups. Group 1 received tetracaine 1% drops and solcoseryl eye gel (Solco Basel AG, Switzerland). Group 2 received xylocaine 2% gel (lidocaine hydrochloride 2% gel, AstraZeneca, Sweden) topically and normal saline drops 0.9%. Additional tetracaine drops were given to patients who experienced pain preoperatively. The primary outcome was the pain experienced during and after surgery. Immediately after the operation, pain and discomfort scores were assessed by the patients and doctor using a 10-point linear analogue scale. The stages of the operation were divided into the following: stage 1-first incision, stage 2-pterygium body excision, stage 3-conjunctival suturing, and stage 4-immediate postoperative after patching. There was no statistically significant difference in the mean pain scores experienced during pterygium excision (3.03+/-2.35 for the lidocaine group and 3.98+/-2.18 for the tetracaine group). However, for stage 3, there was a statistically significant difference in mean pain scores experienced during closure (P=0.03) (0.47+/-0.84 for the lidocaine gel group and 1.43+/-1.66 for the tetracaine group), with patients of group 2 experienced less pain. The mean number of additional drops required by the eyes in lidocaine gel group was also significantly (0.16+/-0.11) less than the tetracaine group (0.67+/-0.09, P=0.001). Topical administration of lidocaine 2% gel or tetracaine 1 % drops are both effective anaesthetic agents for primary pterygium surgery and mitomycin C. However, lidocaine gel is superior to tetracaine eye drops and its application is more convenient with a less frequent application and a sustained duration of action.

Effect of complete epithelial debridement before riboflavin–ultraviolet-A corneal collagen crosslinking therapy

To evaluate the importance of complete epithelial removal before riboflavin-ultraviolet-A (UVA) corneal collagen crosslinking therapy. School of Optometry and Vision Sciences, Cardiff University, Wales, United Kingdom. Riboflavin eyedrops were applied at 5-minute intervals for 35 minutes to the anterior corneal surface of 36 porcine eyes (12 with no epithelial trauma but treated with tetracaine eyedrops, 12 with superficial epithelial trauma but with an intact basal epithelium, and 12 with a fully removed epithelium). The corneal surface of 6 tetracaine-treated eyes, 6 eyes with superficial epithelial trauma, and 6 eyes with a fully removed epithelium was exposed to UVA light for 30 minutes during riboflavin administration. The light transmission spectra of the enucleated corneas were analyzed with a spectrophotometer and compared with those of 9 untreated porcine corneas. Corneas with a fully removed epithelium treated with riboflavin showed an abnormal dip in the transmission spectrum between 400 nm and 510 nm (P<.01). This was attributed to the presence of riboflavin in the corneal stroma. The spectra of riboflavin-treated corneas with no epithelial trauma but tetracaine administration and those with superficial epithelial trauma did not differ from those of the non-riboflavin-treated controls. Exposure to UVA following riboflavin administration did not alter corneal light transmission. Complete removal of the corneal epithelium is an essential component of riboflavin-UVA crosslinking therapy as superficial epithelial trauma and tetracaine administration alone are not sufficient to permit the penetration of riboflavin into the corneal stroma. Failure to achieve adequate stromal absorption of riboflavin may impair the efficacy of the crosslinking process.

Strabismus surgery under subconjunctival anesthesia: technique and evaluation by patient and his surgeon

In adults, eye muscle surgery can be performed under local anesthesia without retrobulbar injection. We wanted to know how patients and surgeons perceive this procedure. 50 patients and 3 surgeons were interviewed with a questionnaire after operation on one or two straight eye muscles, including revisions in 11 cases. The patients were sedated with benzodiazepines. The conjunctiva was anesthetized with tetracaine eye drops. During the operation, mepivacaine was irrigated under the muscle insertion using a blunt needle. The patients perceived little or no pain during the operation. This corresponded to the surgeon's judgement. 96% of the patients would prefer local over general anesthesia in case of a second operation. The technique can be recommended for surgery of rectus muscles in adults, even in the case of revision.