Skip to main content Accessibility help

Dilute proparacaine for the management of acute corneal injuries in the emergency department

  • Ian Michael Ball (a1), Jamie Seabrook (a2), Nimesh Desai (a3), Larry Allen (a3) and Scott Anderson (a1)...



Dogma discourages the provision of topical anesthetics to patients with corneal injuries discharged from the emergency department because of the toxicity of concentrated solutions. We compared the analgesic efficacy of dilute topical proparacaine with placebo in emergency department patients with acute corneal injuries.


We conducted a prospective randomized controlled trial of adults with corneal injuries presenting to one of 2 tertiary care emergency departments in London, Ont. Patients were randomly assigned to groups receiving either 0.05% proparacaine or placebo drops as outpatients and were followed up to healing by a single ophthalmologist. Our primary outcome was pain reduction as measured on a 10-cm visual analog scale.


Fifteen participants from the proparacaine group and 18 participants from the placebo group completed the study. The mean age of the patients was 38.7 (standard deviation 12.3) years and the majority were male (85%). Pain reduction was significantly better in the proparacaine group than in the placebo group, with a median improvement of 3.9 (interquartile range [IQR] 1.5–5.1 ) cm on the visual analog scale versus a median improvement of 0.6 (IQR 0.2–2.0) cm (p = 0.007). The proparacaine group was more satisfied (median level of satisfaction 8.0 [IQR 6.0–9.0] cm on a 10-cm visual analog scale v. 2.6 [IQR 1.0–8.0] cm, p = 0.027). There were no ocular complications or signs of delayed wound healing in either group.


Dilute topical proparacaine is an efficacious analgesic for acute corneal injuries. Although no adverse events were observed in our study population, larger studies are required to evaluate safety.


Corresponding author

Queen's University, Kingston General Hospital, 76 Stuart St., Empire 3, Kingston ON K7L 2V7,


Hide All
1.Calder, L, Balasubramanian, S, Stiell, I. Corneal abrasion management: national survey shows lack of consensus. CJEM 2004;6:402–7.
2.Sher, NA, Frantz, JM, Talley, A, et al. Topical diclofenac in the treatment of ocular pain after excimer photorefractive keratectomy. Refract Corneal Surg 1993;9:425–36.
3.Marx, JARed and painful eye. In: Rosen’s emergency medicine: concepts and clinical practice. 6th ed. Maryland Heights (MO): Mosby Elsevier; 2006. p. 291.
4.Mitchell, JD. Occular emergencies. In: Tintinalli, JE, Gabor, D, Stapczynski, JS, editors. Emergency medicine: a comprehensive study guide. 6th ed. New York (NY): McGraw-Hill Professional; 2004. p. 1455.
5.Havener, WH, Mauger, TF. Ocular pharmacology. 5th ed. St. Louis (MO): CV Mosby; 1983. p. 75–7.
6.Peyman, GA, Rahimy, MH, Fernandes, ML. Effects of morphine on corneal sensitivity and epithelial wound healing: implication for topical analgesia. Br J Ophthalmol 1994;78:138–41.
7.Duffin, RM, Olson, RJ. Tetracaine toxicity. Ann Ophthalmol 1984;16:836–8.
8.Epstein, DL, Paton, D. Keratitis from the misuse of corneal anesthetics. N Engl J Med 1968;279:396–9.
9.Bartfield, JM, Holmes, TJ, Raccio-Robak, N. A comparison of proparacaine and tetracaine eye anesthetics. Acad Emerg Med 1994;1:364–7.
10.Guzey, M, Ahmet, S, Dogan, B, et al. The effects of bupivicaine and lidocaine on the corneal endothelium when applied into the anterior chamber at the concentrations supplied commercially. Ophtha mo ogica 2002;216:113–7.
11.Eggeling, P, Pleyer, U, Hartmann, C. Corneal endothelial toxicity of different lidocaine concentrations. J Cataract Refract Surg 2000;26:1403–8.
12.Chang, YS, Tseng, SH, Chen, FKet al. Cytotoxicity of lidocaine or bupivacaine on corneal endothelial cells in a rabbit model. Cornea 2006;25:590–6.
13.Verma, S, Corbett, MC, Patmore, A, et al. 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;7:327–33.
14.Brilakis, HS, Thomas, MD, Deutsch, A. Topical tetracaine with bandage soft contact lens pain control after photorefractive keratectomy. JRefract Surg. 2000;16:444–7.
15.Shahinian, L, Jain, S, Jager, RD, et al. Dilute topical proparacaine for pain relief after photorefractive keratectomy. Ophthalmology 1997;104:1327–31.
16.Price, DD, McGrath, PA, Rafii, A, et al. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983;17:4556.
17.Judge, AJ, Nafaji, K, Lee, DA, et al. Corneal endothelial toxicity of topical anesthesia. Ophthalmology 1997;104:1373–9.
18.Rocha, G, Brunette, I, Le Francois, M. Severe toxic keratopathy secondary to topical anesthetic abuse. Can J Ophthalmol 1995;30:198202.
19.Pharmakakis, NM, Katsimpris, JM, Melachrinou, MP, et al. Corneal complications following abuse of topical anesthetics. Eur J Ophthalmol 2002;12:373–8.
20.Chen, HT, Chen, KH, Hsu, WM. Toxic keratopathy associated with abuse of low dose anesthetic: a case report. Cornea 2004;23:527–9.
21.Ansari, H, Garibaldi, DC, Jun, AS. Anaesthetic abuse keratopathy as a manifestation of ocular Munchausen’s syndrome. Clin Experiment Ophthalmol 2006;34:81–3.
22.Varga, JH, Rubinfeld, RS, Wolf, TC, et al. Topical anesthetic abuse ring keratitis: report of four cases. Cornea 1997;16:424–9.
23.Kim, JY, Choi, YS, Lee, JH. Keratitis from corneal anesthetic abuse after photorefractive keratectomy. J Cataract Refract Surg 1997;23:447–9.
24.Sugar, A. Topical anesthetic abuse after radial keratectomy. J Cataract Refract Surg 1998;24:1535–7.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed