A topical anesthetic is a

local anesthetic A local anesthetic (LA) is a medication that causes absence of all sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensati ...

that is used to numb the surface of a body part. They can be used to numb any area of the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

as well as the front of the eyeball, the inside of the

nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...

, ear or

throat In vertebrate anatomy, the throat is the front part of the neck, internally positioned in front of the vertebrae. It contains the Human pharynx, pharynx and larynx. An important section of it is the epiglottis, separating the esophagus from the t ...

, the

anus In mammals, invertebrates and most fish, the anus (: anuses or ani; from Latin, 'ring' or 'circle') is the external body orifice at the ''exit'' end of the digestive tract (bowel), i.e. the opposite end from the mouth. Its function is to facil ...

and the genital area. Topical anesthetics are available in creams, ointments, aerosols, sprays, lotions, and jellies. Examples include

benzocaine Benzocaine, sold under the brand name Orajel amongst others, is a local anesthetic, belonging to the amino ester drug class, commonly used as a topical painkiller or in cough drops. It is the active ingredient in many over-the-counter ...

, butamben, dibucaine,

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia and ventricular fibrillation. When used for local anae ...

, oxybuprocaine, pramoxine, proxymetacaine (proparacaine), and tetracaine (also named amethocaine).

Usage

Topical anesthetics are used to relieve

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

and

itch An itch (also known as pruritus) is a sensation that causes a strong desire or reflex to scratch. Itches have resisted many attempts to be classified as any one type of sensory experience. Itches have many similarities to pain, and while both ...

ing caused by conditions such as sunburn or other minor burns, insect bites or stings,

poison ivy Poison ivy is a type of allergenic plant in the genus '' Toxicodendron'' native to Asia and North America. Formerly considered a single species, '' Toxicodendron radicans'', poison ivies are now generally treated as a complex of three separate s ...

, poison oak, poison sumac, and minor cuts and scratches.DrLinhart.com
/ref> Topical anesthetics are used in

ophthalmology Ophthalmology (, ) is the branch of medicine that deals with the diagnosis, treatment, and surgery of eye diseases and disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a ...

and

optometry Optometry is the healthcare practice concerned with examining the eyes for visual defects, prescribing corrective lenses, and detecting eye abnormalities. In the United States and Canada, optometrists are those that hold a post-baccalaureate f ...

to numb the surface of the eye (the outermost layers of the

cornea The cornea is the transparency (optics), transparent front part of the eyeball which covers the Iris (anatomy), iris, pupil, and Anterior chamber of eyeball, anterior chamber. Along with the anterior chamber and Lens (anatomy), lens, the cornea ...

and

conjunctiva In the anatomy of the eye, the conjunctiva (: conjunctivae) is a thin mucous membrane that lines the inside of the eyelids and covers the sclera (the white of the eye). It is composed of non-keratinized, stratified squamous epithelium with gobl ...

) to: * Perform a contact/applanation tonometry. * Perform a Schirmer's test (The Schirmer's test is sometimes used with a

topical A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

eye 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. In

dentistry Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the Human tooth, teeth, gums, and Human mouth, mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, dis ...

, topical anesthetics are used to numb oral tissue before administering a dental

due to the entry of the needle into the soft tissues of the oral cavity. Dental anesthetic gels are sometimes flavored to make usage more tolerable for patients, especially in pediatric dentistry. Some topical anesthetics (e.g. oxybuprocaine) are also used in

otolaryngology Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspecialty within medicine that deals with the surgical an ...

. Topical anesthetics are sometimes abused for 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 as

over-the-counter drug Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid pres ...

Abuse when used for ocular pain relief

When used excessively, topical anesthetics can cause severe and irreversible damage to corneal tissues and even loss of the eye. 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 chronic keratitis, masquerading as acanthamoeba keratitis or other infectious keratitis. When a keratitis is unresponsive to treatment and associated with strong ocular pain, topical anesthetic abuse should be considered, and a history of psychiatric disorders and other substance abuse have been implicated as important factors in the diagnosis. Because of the potential for abuse, clinicians have been warned about the possibility of theft and advised against prescribing topical anesthetics for therapeutic purposes. Some patients who have eye pain, which is often considerably strong

neuropathic pain Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Neuropathic pain may be associated with abnormal sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuo ...

caused by the irritation of the nerves within the cornea and/or conjunctiva, try to illegally obtain oxybuprocaine or other eye anesthetics (for example by stealing them at their

ophthalmologist Ophthalmology (, ) is the branch of medicine that deals with the diagnosis, treatment, and surgery of eye diseases and disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Following a ...

optometrist Optometry is the healthcare practice concerned with examining the eyes for visual defects, prescribing corrective lenses, and detecting eye abnormalities. In the United States and Canada, optometrists are those that hold a post-baccalaureate f ...

, by

forging Forging is a manufacturing process involving the shaping of metal using localized compression (physics), compressive forces. The blows are delivered with a hammer (often a power hammer) or a die (manufacturing), die. Forging is often classif ...

medical prescription A prescription, often abbreviated or Rx, is a formal communication from physicians or other registered healthcare professionals to a pharmacist, authorizing them to dispense a specific prescription drug for a specific patient. Historicall ...

s or by trying to order it via an online pharmacy) and use the substance to numb their eye pain, often ending up with irreversible corneal damage or even destruction (which is a

vicious cycle A vicious circle (or cycle) is a complex chain of events that reinforces itself through a feedback loop, with detrimental results. It is a system with no tendency toward equilibrium (social, economic, ecological, etc.), at least in the short ...

and causes more pain). Often, such patients finally require corneal transplantation. In case of prolonged or chronic eye pain, especially neuropathic eye pain, it is highly advisable to use centrally acting substances like

anticonvulsants Anticonvulsants (also known as antiepileptic drugs, antiseizure drugs, or anti-seizure medications (ASM)) are a diverse group of pharmacological agents used in the treatment of epileptic seizures. Anticonvulsants are also used in the treatment ...

(

pregabalin Pregabalin, sold under the brand name Lyrica among others, is an anticonvulsant, analgesic, and anxiolytic amino acid medication used to treat epilepsy, neuropathic pain, fibromyalgia, restless legs syndrome, opioid withdrawal, generalized anx ...

, gabapentin and in more serious cases carbamazepine) or

antidepressants Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction. Common side effects of antidepressants include dry mouth, weight gain, dizziness, headaches, akathisia, sexu ...

(for example

SSRI Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of major depressive disorder, anxiety disorders, and other psychological conditions. SSRIs primarily work by ...

s or the

tricyclic antidepressant Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants. TCAs were discovered in the early 1950s and were marketed later in the decade. They are named after their chemical structure, which contains ...

amitriptyline). 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.

Notes

External links

Principles of Office Anesthesia: Part II. Topical Anesthesia
{{Anesthesia

Local anesthetics Anesthesia

Usage

Abuse when used for ocular pain relief

See also

Notes

External links