Anesthetic keratopathy from prolonged and uncontrolled use has been reported as far back as 1956.^9,10 Since that time, many articles have been published but were editorials based on historical opinion as opposed to evidence, studies using mouse and rabbit corneas, and an impressively long list of case reports. The volume is nearly as impressive as the 60-plus years of poor-quality or nonexistent evidence used to perpetuate this myth.

Emergency physicians are efficient in our work and our thinking. Four years and a small number of good-quality studies, and we have our answer. Short-term topical anesthetics have never been proven to cause injury or delay healing, and 24-hour use in simple corneal abrasions is certainly safe, particularly with dilution.³ It’s time to open the eyes of some ophthalmologists who believe that years of dogma and reams of poor evidence is a substitute for common sense and a small number of good-quality studies.

References

1. 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):374-382.
2. Puls HA, Cabrera D, Murad MH, et al. Safety and effectiveness of topical anesthetics in corneal abrasions: systematic review and meta-analysis. J Emerg Med. 2015;49(5):816-824.
3. Swaminathan A, Otterness K, Milne K, et al. The safety of topical anesthetics in the treatment of corneal abrasions: a review. J Emerg Med. 2015;49(5):810-815.
4. Waldman N, Winrow B, Densie I, et al. 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. 2018;71(6):767-778.
5. Pruet CM, Feldman RM, Kim G. Re: “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(9):1062-1063.
6. Upadhyay MP, Karmacharya PC, 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(4):388-392.
7. Erdem E, Undar IH, Esen E, et al. Topical anesthetic eye drops abuse: are we aware of the danger? Cutan Ocul Toxicol. 2013;32(3):189-193.
8. Rosenwasser GO, Holland S, Pflugfelder SC, et al. Topical anesthetic abuse. Ophthalmology. 1990;97(8):967-972.
9. Behrendt T. Experimental study of corneal lesions produced by topical anesthesia. Am J Ophthalmol. 1956;41(1):99-105.
10. Marr WG, Wood R, Senterfit L, et al. Effect of topical anesthetics on regeneration of corneal epithelium. Am J Ophthalmol. 1957;43(4 Part 1):606-610.