Tetracaine (Ophthalmic)

Tetracaine blocks the entry of sodium ions into nerve cells which interferes with the generation of nerve impulses that send pain sensations.

Overview

Tetracaine is a prescription drug used to numb the eyes. It comes in the form of a topical local anesthetic eyedrop and works by blocking the entry of sodium ions into nerve cells. When this happens, it decreases the ability of the nerves to generate the impulses needed to send pain sensations. The primary use of this medication is to numb the eye before surgery, to perform tests, and for different procedures. The eye drops are used to prevent pain during different procedures. Tetracaine is part of the drug family classified as local anesthetics. This drug blocks the pain signals sent by the nerve endings in the eye. It's available in three different brands: Altacaine, Tetcaine, TetraVisc, TetraVisc Forte. It comes in the form of a solution and is administered with eyedrops. Its chemical name is Benzoic acid, 4-(butylamino)-, 2-(dimethylamino)ethyl ester, monohydrochloride. Its active ingredients and chemical composition are Tetracaine Hydrochloride 0.5%; Preservative: Chlorobutanol; Inactive: Boric Acid, Edetate Disodium, Potassium Chloride, Water for Injection, USP, Hydrochloric Acid and/or Sodium Hydroxide to adjust pH.

Conditions treated:

  • Pain

Type of Medicine:

  • Local Anesthetic

Side Effects:

As with any medication, Tetracaine can produce some common side effects. These side effects can include eye pain, skin rash, itching, hives, sensitivity to light, and swelling of the eye or eyelid. If you experience any of these reactions, seek medical attention immediately. However, there are other side effects that are also common but don't usually require medical attention. They include burning, stinging, redness, irritation, and watering of the eyes. Unfortunately, it is possible to experience less common side effects that would require medication. These side effects include blurred vision, redness of the clear part of the eye, sensitivity to light, severe stinging in the eye, tearing, and throbbing eye pain. Many severe side effects have not been reported enough to determine their frequency, however, they are severe enough to warrant medical attention. They include bloody eyes, burning, stinging, itching, redness, and changes in vision. There have been incidences of acute diffuse epithelial keratitis with filament formation and/or sloughing of large areas of the necrotic epithelium. In addition, other extreme side effects have included diffuse stromal edema, descemetitis and iritis.

It is possible to experience additional side effects that haven't been reported. If additional side effects occur, seek medical attention as soon as possible. You can also report any unlisted side effects to the FDA (1-800-FDA-1088).

Dosage:

This medication is not meant to be administered by the patient. Instead, this medicine is administered by a medical professional in a doctor's office, hospital, or clinic. However, before a medical professional administers this medication, it is extremely important that the patient provide as much information as possible regarding any other medications that he or she may be taking, contact lens wear, infection, unusual allergic reactions to tetracaine or anything else, and your pregnancy or breastfeeding status. It should also be noted that this medicine is not meant to be used by the patient directly or without the supervision of a physician. Once the drops are applied, the eyes should not be touched. The medicine has a numbing effect. You will lose the ability to feel if you are doing anything harmful to your eyes.

It should be noted that this medication is not meant to be used for a long period of time. If your condition fails to improve, you should seek medical attention. In addition, if you wear contact lenses, do not resume wearing them until after the effects of the medicine have worn off.

The adult ophthalmic solution usually comes in a 0.5% solution and is available in 15 mL and 30 mL single drop plastic containers. The dosing is usually determined by the type of procedure that will be performed as well, or by the intended use. For short-term anesthesia, 1-2 drops into the affected eye just prior to evaluation is the usual recommended dose. For minor surgical procedures, 1-2 drops per minute for 5-10 minutes before the procedure is the recommended dose. Lastly, prolonged surgical procedures generally require 1-2 drops per minute for 5-10 minutes, not to exceed 5 doses. Typically, the effects of this anesthetic take 10-20 seconds to take effect and last 10- 20 minutes. This drug is used when a quick short-acting topical ophthalmic anesthetic is needed for particular procedures.

Drug Interactions:

Along with the desired effects of any medication, there may be adverse effects that occur when two drugs are used at the same time. If you experience any adverse reactions you should seek medical attention immediately. There are drugs that have been determined to produce negative interactions with Tetracaine. Included below is a list of some of the drugs known to have an interaction with Tetracaine ophthalmic:

  • Americaine (benzocaine topical)
  • Cytomel (liothyronine)
  • Levaquin (levofloxacin)
  • Levoxyl (levothyroxine)
  • Lexapro (escitalopram)
  • LidaMantle (lidocaine topical)
  • Lidoderm (lidocaine topical)
  • Lyrica (pregabalin)
  • Metoprolol Succinate ER (metoprolol)
  • Norco (acetaminophen / hydrocodone)
  • Orajel (benzocaine topical)
  • Pramox (pramoxine topical)
  • Pristiq (desvenlafaxine)
  • Ranexa (ranolazine)
  • Savella (milnacipran)
  • Synthroid (levothyroxine)
  • Tylenol (acetaminophen)
  • Vitamin D3 (cholecalciferol)
  • Xylocaine HCl For Spinal (lidocaine)
  • Zyrtec (cetirizine)
  • Hyaluronidase
  • St. John's Wort

Warnings:

Tetracaine ophthalmic is intended for topical ophthalmic use only. It should be administered by a medical professional and is not intended for parenteral use. It is also not meant for injection. Tetracaine eyedrops should not be used if the solution contains crystals or appears cloudy or discolored. If this drug is used for a prolonged period of time a decrease in the duration of anesthesia and retarded healing may occur. This, in turn, may cause the drug to be used more frequently, creating a predisposition to corneal infection and/or corneal opacification. Both conditions could lead to accompanying permanent visual loss or corneal perforation. Severe keratitis could occur as well.

In order to avoid contamination, do not touch the dropper tip to any surface. It's extremely important to avoid eye irritating chemicals, foreign bodies and rubbing while the effects of the anesthesia are still present. Tetracaine Hydrochloride Ophthalmic Solution, USP 0.5% should be used carefully and with caution in patients with allergies or cardiac disease. If a patient develops signs of sensitivity during the treatment or irritation continues or increases, discontinue use and seek medical attention.

Inadequate studies have been done to determine whether or not Tetracaine would be harmful to the fetus if taken by pregnant women. The effects of breastfeeding are not clear either. This medication should only be given to pregnant or breastfeeding women if cleared by a physician.

Clinical trials have shown that this drug is generally safe for both pediatric and geriatric use. However, there has been no conclusive data generated to determine the efficacy of any effects on fertility. However, a variety of other conditions can result from the use of this drug. Some of these conditions are listed below.

  • Anxiety
  • Restlessness
  • Nervousness
  • Dizziness
  • Blurred vision
  • Conjunctival redness
  • Lacrimation
  • Photophobia
  • Tremors
  • Twitching
  • Drowsiness
  • Unconsciousness
  • Respiratory arrest
  • Nausea/vomiting
  • Chills
  • Tinnitus
  • Myocardial depression
  • Hypotension

Storage:

Tetracaine ophthalmic should be stored at room temperature, 15°-30°C (59°-86°F). In addition, the container should be kept tightly closed and away from light and heat.

Summary

Tetracaine ophthalmic is a prescription medication that comes in the form of an eyedrop solution. It is administered by a medical professional as a local anesthetic for a variety of different procedures. It numbs the eye, allowing surgical procedures as well as other actions to occur, without pain or irritation to the eye. Once administered, this drug takes 10 to 20 seconds to take effect and the effects generally last between 10 and 20 minutes. This drug can produce side effects that range from mild to severe. If any negative side effects occur, you should contact a medical professional. In addition to negative side effects, it's possible for tetracaine to interact negatively with other drugs when taken at the same time. Generally, a physician will attempt to make adjustments to one or both medications to alleviate the adverse reactions. In the worst case scenario, it may be necessary to avoid taking a particular drug in conjunction with tetracaine, if the adverse reactions are too severe and can't be managed. This drug should be kept out of reach of children and stored at room temperature, away from light and heat. There have been inadequate or insufficient studies done to determine the efficacy of this drug on pregnant and breastfeeding women. Conversely, clinical trials have proven this medication to be generally safe for geriatric and pediatric patients, unless otherwise determined not to be.

Prolonged use of this drug is not recommended and could lead to compromised vision or the loss of vision, in addition to other conditions. The overuse of this medication can even lead to diminished anesthetic effects, requiring more of the drug to achieve the same effects. This is one of the reasons why this medication is meant to be administered under a doctors supervision and used for a brief period of time.

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Last Reviewed:
December 24, 2017
Last Updated:
February 11, 2018
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