Topical anaesthetics: why they are never sent home
- Drugs and toxicity
Anaesthetic drops are for examining the eye, never for home. Repeated use destroys the corneal surface and can perforate the eye.
See it in 3D: Cornea
What it is
Topical anaesthetic drops such as tetracaine numb the cornea within seconds. They are essential to examine a painful eye, remove a foreign body or measure eye pressure, and their relief in the exam room helps locate the pain on the surface. Used repeatedly, however, they are toxic to the corneal epithelium, stop healing, remove the protective blink and pain, and can lead to severe keratitis, ulceration and perforation.
What to know
- Use: examination, foreign body removal, tonometry, irrigation of chemical burns.
- Effect lasts minutes; repeated doses delay epithelial healing.
- Abuse leads to a non-healing epithelial defect, ring-shaped corneal infiltrate and possible perforation.
- Patients who get a bottle may keep using it because the relief is immediate.
Toxicity and risks
- Unexplained, non-healing corneal ulcers in a person who works around chemicals or welding should prompt a question about anaesthetic drop use.
- Pain after an abrasion is controlled with oral analgesics, a cycloplegic drop and sometimes a topical anti-inflammatory, not with anaesthetics.
- Anaesthetic abuse keratopathy can mimic Acanthamoeba or fungal keratitis.
Next step / Initial management
- Never prescribe or hand over anaesthetic drops for home use.
- Abrasion pain: oral analgesia, cycloplegic drop for spasm, antibiotic drops, review in 24 to 48 hours.
- Suspected anaesthetic abuse: stop the drops, same-day ophthalmology, and address the reason for the misuse.
- Keep anaesthetic bottles under control in emergency departments.
Test yourself
Think of the answer, then tap the question to see it.
Why are topical anaesthetic drops never prescribed for home use?
Repeated use is toxic to the corneal epithelium, prevents healing and can cause ulceration and perforation.
How is pain from a corneal abrasion controlled?
With oral analgesics, a cycloplegic drop and antibiotic drops, without anaesthetic drops.
What does anaesthetic abuse keratopathy look like?
A non-healing epithelial defect, often with a ring-shaped infiltrate, that can mimic infectious keratitis.
Connections
See it in 3D1
The structures of Durgical's 3D anatomy where it is found.
In Pharmacology3
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Tetracaine (StatPearls Publishing (NCBI Bookshelf), 2025); Corneal Abrasion (StatPearls Publishing (NCBI Bookshelf), 2024).
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Representative model, for educational purposes only.