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 th e efficacy and safety to the cornea of a limited amount of topical tetracai ne 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. App roximately 10 drops of commercial, non-preserved 0.5% tetracaine were given to patients to use when needed to control severe pain. A bandage soft cont act 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 tet racaine drops used was noted. No systemic analgesic or topical non-steroida l anti-inflammatory was prescribed. RESULTS: All eyes healed within 3 days. The mean number of drops of tetraca ine used was 2.3 drops over 3 days, although in 33 eyes (48%) the patient d id not use any tetracaine. There was no correlation between the attempted c orrection in diopters and the number of drops used. No significant differen ce 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 an algesic option after PRK. Use of tetracaine in this protocol did not prolon g the time to re-epithelialization. Giving only a limited amount of tetraca ine to patients prevents abuse and toxicity to the cornea while managing se vere pain.