FOAMcast - An Emergency Medicine Podcast · FOAMcast

Topical Anesthetics in Corneal Abrasions - A Consensus Guideline from ACEP

·20 min·1 clip

The AAO backed the literature summaries but refused to endorse the patient-care recommendations.

1. FOAMcast discusses the ACEP consensus guideline on topical anesthetics for corneal abrasions. 2. Jeremy and Lauren frame corneal abrasions as common, painful “corneal epithelial defects” seen in emergency medicine. 3. The episode asks whether adult ED patients with simple corneal abrasions can safely use topical anesthetics for 24 hours. 4. The hosts describe the ACEP recommendation for proparacaine, tetracaine, or oxybuprocaine up to every 30 minutes as needed. 5. They specify a total dispense amount of 1.5 to 2 milliliters and say any remainder should be discarded after 24 hours. 6. The evidence discussion includes animal studies, basic science, case reports, case series, randomized ED trials, and post-PRK data. 7. The hosts note that toxicity concerns center on impaired corneal healing, especially with higher doses and longer use. 8. They describe the guideline’s definition of a simple corneal abrasion as a practical bedside judgment rather than a precise formal category. 9. The exclusion list includes corneal penetration, laceration, positive Seidel testing, chemical injury, thermal injury, UV photokeratitis, infection, gross contamination, retained foreign body, and rust ring. 10. The hosts also exclude herpetic eye disease, prior corneal pathology, recent ocular surgery, and pediatric patients from the recommendation. 11. Jeremy says the patient should be told the medication is limited to 24 hours and that follow-up should occur in 48 to 72 hours. 12. Lauren notes that small bottles or deliberately wasted vials can limit misuse by leaving only a few doses for home use. 13. The episode highlights that the literature supports short-course use more than older dogma suggested. 14. The hosts say the studies are not powered to detect rare complications, which leaves some uncertainty about uncommon harms. 15. They mention that the recommendation appears more effective than acetaminophen with or without an opioid. 16. The episode spends significant time on the AAO and ACEP process, including the AAO’s request to jointly issue guidance. 17. The hosts describe the tone of the manuscript as unusually candid about the disagreement over recommendations. 18. The delivery is conversational and argumentative, with repeated back-and-forth between Jeremy and Lauren. 19. Listeners interested in emergency medicine practice changes and corneal abrasion care will get the most from it. 20. Listeners seeking a brief, non-technical overview of eye anatomy should skip it.

As heard by us

A practical reminder to numb a simple corneal abrasion without skipping the eye exam.

A corneal abrasion is miserable, even when the fix is straightforward, and the episode does its best work when it stays on careful exam work before comfort.

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Why you'd press play

A bedside take on corneal abrasion care, translated into what you actually do in the ED.

Read the full recommendation in PlayNext →

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