• Home
• GJF
  • Joint Wound Care Formulary
  • . . . Introduction
  • 1. Gastro-Intestinal System
  • 2. Cardiovascular System
  • 3. Respiratory System
  • 4. Central Nervous System
  • 5. Infections
  • 6. Endocrine System
  • 7. Obstetrics, Gynaecology and Urinary Tract Disorders
  • 8. Malignant Disease and Immunosuppresion
  • 9. Nutrition and Blood
  • 10. Musculoskeletal and Joint Disease
  • 11. Eye
    • 11.1 Administration of drugs to the eye
    • 11.2 Control of microbial contamination
    • 11.3 Anti-infective eye preparations
    • 11.4 Corticosteroids and other anti-inflammatory preparations
    • 11.5 Mydriatics and cyclopegics
    • 11.6 Treatment of glaucoma
    • 11.7 Local anaesthetics
    • 11.8 Miscellaneous ophthalmic preparations
  • 12. Ear, Nose and Oropharynx
  • 13. Skin
  • 14. Immunological products and vaccines
  • 15. Anaesthesia
  • Appendix 1. Drugs for emergency use in General Practice
  • Appendix 2. Palliative Care
  • Appendix 3. Oral Nutritional Supplements (ONS)
  • Appendix 4. Gluten-free and cow's milk protein-free products
  • Medicines No Longer included in the GJF
  • Medicines not recommended for use in NHS Grampian
• eGJF
• Medicines Management
• Policies
• News Letters
• Shared Care Protocols
• Patient Group Directions

11.7 Local anaesthetics

Oxybuprocaine hydrochloride 0.4% (benoxinate hydrochloride, single use eye drops) is the recommended local anaesthetic for ophthalmic use. It causes less initial irritation than tetracaine and has a very rapid onset of action (about 30 seconds).

Lidocaine 4% and fluorescein 0.25% (single use eye drops) is used in tonometry. Avoid in preterm neonates.

Proxymetacaine 0.5% (single dose eye drops) causes less initial stinging and is useful for children. Use with care in preterm neonates.

Proxymetacaine 0.5% and fluoresceine 0.25% (single dose eye drops). Avoid in preterm neonates. Used as for lidocaine/fluorescein.

Tetracaine 0.5% and 1% (single use eye drops) has a longer duration of action than oxybuprocaine but is more likely to cause stinging, which may be extremely painful.

SPECIAL INDICATIONS

Cocaine 4% eye drops [unlicensed product] has local anaesthetic and vasoconstrictor actions. It is used in the diagnosis of Horner's syndrome and as a nasal vasoconstrictor prior to DCR surgery.

PRESCRIBING POINTS FOR LOCAL ANAESTHETICS

• Local anaesthetic eye drops should not be used for the symptomatic control of pain. Not recommended for welders flash, other than for diagnostic purposes.
• Local anaesthetics should never be used for the management of ocular symptoms.
• The use of local anaesthetic eye drops is essential when removing foreign bodies from the eye.
• Patients should be warned that the eye drops might sting.
• One drop instilled and repeated once after 1 minute will provide effective ocular surface anaesthesia for 10-20 minutes.

PAEDIATRIC NOTES - LOCAL ANAESTHETICS

Local anaesthetic eye drops should be used with care in preterm neonates because of the immaturity of the metabolising enzyme system.

Oxybuprocaine hydrochloride 0.4% eye drops is recommended for paediatric use as tetracaine may cause stinging and corneal epithelial damage. Proxymetacaine causes less initial stinging and is useful for children.

Previous: Treatment of glaucoma | Top | Next: Miscellaneous ophthalmic preparations