Atopical anestheticis alocal anestheticthat is used to numb the surface of a body part. They can be used to numb any area of theskinas well as the front of theeyeball,the inside of thenose,earorthroat,theanusand thegenital area.[1]Topical anesthetics are available in creams, ointments, aerosols, sprays, lotions, and jellies. Examples includebenzocaine,butamben,dibucaine,lidocaine,oxybuprocaine,pramoxine,proxymetacaine(proparacaine), andtetracaine(also named amethocaine).[citation needed]
Usage
editTopical anesthetics are used to relievepainanditchingcaused by conditions such as sunburn or other minor burns, insect bites or stings,poison ivy,poison oak,poison sumac,and minor cuts and scratches.[2]
Topical anesthetics are used inophthalmologyandoptometryto numb the surface of theeye(the outermost layers of thecorneaandconjunctiva) to:
- Perform acontact/applanation tonometry.
- Perform aSchirmer's test(The Schirmer's test is sometimes used with atopicaleye anesthetic, sometimes without. The use of a topical anesthetic might impede the reliability of the Schirmer's test and should be avoided if possible.).
- Remove small foreign objects from the uppermost layer of the cornea or conjunctiva. The deeper and the larger a foreign object which should be removed lies within the cornea and the more complicated it is to remove it, the more drops of topical anesthetic are necessary prior to the removal of the foreign object to numb the surface of the eye with enough intensity and duration.
Indentistry,topical anesthetics are used to numb oral tissue before administering a dentallocal anestheticdue to the entry of the needle into the soft tissues of the oral cavity.[3]Dental anesthetic gels are sometimes flavored to make usage more tolerable for patients, especially in pediatric dentistry.[4]
Some topical anesthetics (e.g.oxybuprocaine) are also used inotolaryngology.
Topical anesthetics are now commonly used in the temporary relief of premature ejaculation when applied to the glans (head) of the penis. Benzocaine or lidocaine are typically used for this purpose as they are available asover-the-counter drugs.
Abuse when used for ocular pain relief
editWhen used excessively, topical anesthetics can cause severe and irreversible damage to corneal tissues[5][6][7][8][9]and even loss of the eye.[10]The abuse of topical anesthetics often creates challenges for correct diagnosis in that it is a relatively uncommon entity that may initially present as a chronickeratitis,masquerading asacanthamoeba keratitisor otherinfectious keratitis.[5][6][8][10][11]When a keratitis is unresponsive to treatment and associated with strong ocular pain, topical anesthetic abuse should be considered,[8]and a history of psychiatric disorders and other substance abuse have been implicated as important factors in the diagnosis.[5][10][11]Because of the potential for abuse, clinicians have been warned about the possibility of theft and advised against prescribing topical anesthetics for therapeutic purposes.[6][10]
Some patients who have eye pain, which is often considerably strongneuropathic paincaused by the irritation of the nerves within the cornea and/or conjunctiva, try to illegally obtain oxybuprocaine or other eye anesthetics (for example bystealingthem at theirophthalmologistoroptometrist,byforgingmedical prescriptionsor by trying to order it via anonline pharmacy) and use the substance to numb their eye pain, often ending up with irreversible corneal damage or even destruction (which is avicious cycleand causes more pain). Often, such patients finally requirecorneal transplantation.
In case of prolonged or chronic eye pain, especiallyneuropathic eye pain,it is highly advisable to usecentrallyacting substances likeanticonvulsants(pregabalin,gabapentinand in more serious casescarbamazepine) orantidepressants(for exampleSSRIsor thetricyclic antidepressantamitriptyline). Even very small amounts of an anticonvulsant and/or an antidepressant can almost completely stop eye pain and does not damage the eye at all.
See also
editNotes
edit- ^"Healthopedia.com".Archived fromthe originalon 2005-11-26.Retrieved2006-03-30.
- ^DrLinhart.com
- ^Local Anesthesia for the Dental Hygienist,Logothetis, Elsevier, 2012
- ^Ferrazzano, Gianmaria Fabrizio; Di Fabio, Giuseppe; Gatto, Roberto; Caruso, Sara; Botticelli, Gianluca; Caruso, Silvia (2023-02-24)."Effectiveness and Tolerability of a New Formulation of a Topical Anesthetic in Reduction of Pain and Parents' Satisfaction in Pediatric Dentistry".Children.10(3): 444.doi:10.3390/children10030444.ISSN2227-9067.PMC10047767.PMID36980002.
- ^abcPharmakakis NM, Katsimpris JM, Melachrinou MP, Koliopoulos JX (2002). "Corneal complications following abuse of topical anesthetics".Eur J Ophthalmol.12(5): 373–8.doi:10.1177/112067210201200505.PMID12474918.S2CID196168539.
- ^abcVarga JH, Rubinfeld RS, Wolf TC, et al. (July 1997). "Topical anesthetic abuse ring keratitis: report of four cases".Cornea.16(4): 424–9.doi:10.1097/00003226-199707000-00009.PMID9220240.
- ^Chern KC, Meisler DM, Wilhelmus KR, Jones DB, Stern GA, Lowder CY (January 1996). "Corneal anesthetic abuse and Candida keratitis".Ophthalmology.103(1): 37–40.doi:10.1016/s0161-6420(96)30735-5.PMID8628558.
- ^abcArdjomand N, Faschinger C, Haller-Schober EM, Scarpatetti M, Faulborn J (November 2002). "[A clinico-pathological case report of necrotizing ulcerating keratopathy due to topical anaesthetic abuse]".Ophthalmologe(in German).99(11): 872–5.doi:10.1007/s00347-002-0623-z.PMID12430041.S2CID20724555.
- ^Chen HT, Chen KH, Hsu WM (July 2004). "Toxic keratopathy associated with abuse of low-dose anesthetic: a case report".Cornea.23(5): 527–9.doi:10.1097/01.ico.0000114127.63670.06.PMID15220742.S2CID1836290.
- ^abcdRosenwasser GO, Holland S, Pflugfelder SC, et al. (August 1990). "Topical anesthetic abuse".Ophthalmology.97(8): 967–72.doi:10.1016/s0161-6420(90)32458-2.PMID2402423.
- ^abSun MH, Huang SC, Chen TL, Tsai RJ (June 2000). "Topical ocular anesthetic abuse: case report".Chang Gung Med J.23(6): 377–81.PMID10958042.
External links
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