It seems to me that these researchers asked the wrong question. Most of us know that numbing up a corneal abrasion relieves pain. But the big question has always been is it safe to send patients home with topical anaesthetic. For decades, ophthalmologist have been telling us it is dangerous. But lately, this dogma has been challenged with better quality research.
So if they didn't ask the right questions, then why was this study conducted and published in our peak emergency medicine journal?
It turns out we have never proven the efficacy of
topical anaesthetics for outpatient treatment of simple corneal abrasions with
an RCT. Go figure...
But, now we have.
This well conducted RCT out of a single ED in Oklahoma (yeeeehaaaaaaa!)
randomised 111 patients to 2ml’s of tetracaine drops vs placebo to take home. The primary
outcome was the overall NRS pain score at a 24-hour and 48-hour ED follow-up.
As expected, the tetracaine worked marvellously. Pain score
was 1/10 in the tetracaine group and 8/10 in the placebo group. This is a huge
difference with lots of pretty p values. The placebo group also gulped down
more Vicodin than the those given tetracaine (don’t get me started…)
Unfortunately, we cannot make claims about safety with so
few trial participants. A much larger study will be needed to find less common
side effects. But the original studies that suggested harm are old and poor
quality. It seems that the current best evidence suggests topical anaesthetics
are probably safe and definitely effective for simple corneal abrasions.
But don’t be surprised if your local ophthalmologists disagree… it's hard to teach an old dog(ma) new tricks.
Covering:
Shipman S, Painter K, Keuchel M, et al. Short-Term
Tetracaine is Highly Efficacious for the Treatment of Pain Caused by Corneal
Abrasions: A Double-Blind, Randomized Clinical Trial. Ann Emerg Med. 2020 Oct
27;S0196-0644(20)30739-3. doi:
10.1016/j.annemergmed.2020.08.036 [link to article]
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