Topical tetracaine with bandage soft contact lens pain control after photorefractive keratectomy.

PURPOSE A major disadvantage of photorefractive keratectomy (PRK) is pain and discomfort in the first three postoperative days. We tried to assess the efficacy and safety to the cornea of a limited amount of topical tetracaine given to patients for use when needed to manage severe pain. METHODS Sixty-nine eyes of 49 patients who underwent PRK between June 21, 1996 and June 15, 1998 by a single surgeon were prospectively included. Approximately 10 drops of commercial, non-preserved 0.5% tetracaine were given to patients to use when needed to control severe pain. A bandage soft contact lens was applied. Patients were examined at 1 and 3 days after surgery, at which time corneal re-epithelization was assessed and the number of tetracaine drops used was noted. No systemic analgesic or topical non-steroidal anti-inflammatory was prescribed. RESULTS All eyes healed within 3 days. The mean number of drops of tetracaine used was 2.3 drops over 3 days, although in 33 eyes (48%) the patient did not use any tetracaine. There was no correlation between the attempted correction in diopters and the number of drops used. No significant difference was found in the number of drops used in the second eye of patients who had both eyes treated. CONCLUSIONS Limited use of topical anesthetics is an effective and safe analgesic option after PRK. Use of tetracaine in this protocol did not prolong the time to re-epithelialization. Giving only a limited amount of tetracaine to patients prevents abuse and toxicity to the cornea while managing severe pain.