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Journal of AAPOS : the Official... Aug 2015To determine the psychological effects of eyedrops administration in children.
PURPOSE
To determine the psychological effects of eyedrops administration in children.
METHODS
Children requiring eyedrops for cycloplegic refraction were recruited in this cross-sectional study. Nurses administered eyedrops in 2-3 cycles spaced 5-10 minutes apart, and optometrists performed refraction 30 minutes after the last drop. Ophthalmologists, nurses, and optometrists rated the children's cooperation level at first review, after each eyedrop, at refraction, and at final review. Parents chose a personality type best describing their child, and monitored their child's anxiety using a modified Yale Preoperative Anxiety Scale (m-YPAS). Children were "uncooperative" if nurses noted significant distress during the first drop cycle.
RESULTS
A total of 298 children 2-12 years of age were included. Of these, 77 (26%) experienced pre-drop distress and 39 (13%) were uncooperative with drops. Compared to cooperative children, uncooperative children tended to be younger (2.0-4.9 years vs ≥8 years; OR, 4.11; 95% CI, 1.14-14.83; P = 0.031), male (OR, 2.55; 95% CI, 1.06-6.10; P = 0.036), have had a previous negative eyedrop experience (84.2% vs 25.3%; P < 0.001) and were more anxious (m-YPAS scores, 41.4 ± 22.0 vs 30.6 ± 12.6: P < 0.001). Children described as "demanding and aggressive" were more uncooperative than "timid and anxious" children. It took longer to instill drops (3.1 vs 1.3 minutes), and perform refraction (11.6 vs 7.2 minutes) in uncooperative children.
CONCLUSIONS
A small group of children were uncooperative with eyedrops and 26% experienced significant pre-drop anxiety. Factors such as age, sex, a previous negative eyedrop experience, and pre-drop anxiety, associated with uncooperativeness need to be considered when developing strategies to improve the eyedrops experience in children.
Topics: Administration, Topical; Anxiety Disorders; Asian People; Child; Child Behavior; Child, Preschool; Cross-Sectional Studies; Cyclopentolate; Female; Humans; Male; Mydriatics; Ophthalmic Solutions; Patient Compliance; Personality Inventory; Phenylephrine; Propoxycaine; Refraction, Ocular; Singapore; Stress, Psychological; Tropicamide
PubMed: 26296784
DOI: 10.1016/j.jaapos.2015.05.010 -
The Journal of Emergency Medicine Nov 2015Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the... (Review)
Review
BACKGROUND
Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and corneal erosion.
OBJECTIVE
To summarize the evidence for the safety of topical proparacaine and tetracaine for pain relief in patients with corneal abrasions.
METHODS
This is a systematic review looking at the use of topical anesthetic agents in the treatment of corneal abrasions in the emergency department.
RESULTS
Our literature search produced two emergency department-based, randomized, double blind, placebo-controlled studies on human patients with corneal abrasions. Additionally, we found four studies that investigated the application of topical anesthetics in patients who underwent photorefractive keratectomy. All six studies demonstrated that a short course of dilute topical anesthetic provided efficacious analgesia without adverse effects or delayed epithelial healing.
CONCLUSION
Limited available data suggests that the use of dilute topical ophthalmologic proparacaine or tetracaine for a short duration of time is effective, though their safety for outpatient use is inconclusive.
Topics: Anesthetics, Local; Corneal Injuries; Eye Pain; Humans; Propoxycaine; Tetracaine; Wound Healing
PubMed: 26281814
DOI: 10.1016/j.jemermed.2015.06.069 -
The Journal of Toxicological Sciences Aug 2015Proparacaine is a widely used topical anesthetic in ophthalmic optometry and surgery, and has been reported to have cytotoxic effects on rabbit corneal endothelial cells...
Proparacaine is a widely used topical anesthetic in ophthalmic optometry and surgery, and has been reported to have cytotoxic effects on rabbit corneal endothelial cells after prolonged and repeated usage. Since rabbit is an exceptive mammal whose corneal endothelial cells still maintaining proliferation abilities even in adulthood, whether proparacaine has cytotoxic effects on human corneal endothelial (HCE) cells need to be further verified. Our objectives in the present study were to investigate the cytotoxicity to HCE cells of proparacaine and its underlying mechanisms in vitro and verify the cytotoxicity using cat corneal endothelial (CCE) cells in an in vivo model of cat corneas. Cytotoxic evaluation results indicated that a dose- and time-dependent toxic response of HCE cells to proparacaine over 0.03125% was rated based on morphology and viability, and a toxic response of CCE cells to 0.5% (clinical applied dosage) proparacaine was also rated based on cell density and histology. Importantly, treatment with proparacaine resulted in significant elevation of plasma membrane permeability, cell cycle arrest at S phase, fragmentation of genomic DNA, formation of apoptotic bodies, and externalization of phosphatidylserine (PS) of HCE cells. Moreover, proparacaine demonstrated disrupting effects on mitochondrial transmembrane potential (MTP) of HCE cells and activating effects on caspase-3, -8 and -9. This study demonstrates that proparacaine has notable cytotoxicity to both HCE cells in vitro and CCE cells in vivo, and its dose- and time-dependent cytotoxicity to HCE cells is achieved by inducing apoptosis via a mitochondrion-mediated caspase-dependent pathway. These findings provide new insights into the cytotoxicity and apoptosis-inducing effect of local anesthetics which should be used with great caution in the eye clinic.
Topics: Anesthetics, Local; Animals; Apoptosis; Caspases; Cats; Cell Cycle; Cell Membrane Permeability; Cells, Cultured; DNA Fragmentation; Dose-Response Relationship, Drug; Endothelial Cells; Endothelium, Corneal; Humans; Membrane Potential, Mitochondrial; Phosphatidylserines; Propoxycaine; Rabbits; S Phase; Time Factors
PubMed: 26165639
DOI: 10.2131/jts.40.427 -
Pediatrics and Neonatology Dec 2015To report the success rates of office probing for congenital nasolacrimal duct obstruction (NLDO) among children of different age groups in Taiwan.
BACKGROUND
To report the success rates of office probing for congenital nasolacrimal duct obstruction (NLDO) among children of different age groups in Taiwan.
METHODS
In this single-center, retrospective study, 564 eyes of 477 patients under the age of 5 years diagnosed with congenital NLDO were treated in a stepwise manner between 2001 and 2013. For infants aged < 6 months, treatment with massage and observation was suggested, followed by deferred probing under topical anesthesia if symptoms persisted. However, in cases of severe infection, immediate probing was suggested. In children aged > 6 months, office probing was usually highly recommended. Those with probing failures received either a second probing or silicone intubation. Treatment success was defined as anatomic patency by immediate irrigation after probing and absence of epiphora or mucous discharge at the follow-up visit.
RESULTS
Primary probing was successful in 457 of 564 eyes (success rate: 81%). The success rate of primary probing was negatively correlated with increasing age: 90.1% (163/181), 79.6% (164/206), 76.8% (73/95), 73.5% (36/49), 75% (18/24), and 33% (3/9) for the age groups of 0 to <6 months, 6 to <12 months, 12 to <18 months, 18 to <24 months, 24 to <36 months, and 36-60 months, respectively (p < 0.001, Fisher's exact test). The second probing was successful in 52 of 81 eyes. In total, probing was successful in 509 of 564 eyes (success rate: 90.2%).
CONCLUSION
Office probing is safe and effective for treating congenital NLDO. The success rate of primary probing decreases significantly with age.
Topics: Age Factors; Ambulatory Surgical Procedures; Anesthetics, Local; Child, Preschool; Dacryocystorhinostomy; Female; Humans; Infant; Infant, Newborn; Lacrimal Duct Obstruction; Male; Nasolacrimal Duct; Propoxycaine; Retrospective Studies; Taiwan
PubMed: 26026949
DOI: 10.1016/j.pedneo.2015.04.001 -
Investigative Ophthalmology & Visual... May 2015Dry eye disease (DED) produces ocular pain and irritation, yet a detailed characterization of ocular sensitivity in a preclinical model of DED is lacking. The aim of the...
PURPOSE
Dry eye disease (DED) produces ocular pain and irritation, yet a detailed characterization of ocular sensitivity in a preclinical model of DED is lacking. The aim of the present study was to assess nociceptive behaviors in an aqueous tear deficiency model of DED in the rat.
METHODS
Spontaneous blinking, corneal mechanical thresholds, and eye wipe behaviors elicited by hypertonic saline (5.0 M) were examined over a period of 8 weeks following the unilateral excision of either the exorbital lacrimal gland or of the exorbital and infraorbital lacrimal glands, and in sham surgery controls. The effect of topical proparacaine on spontaneous blinking and of systemic morphine (0.5-3.0 mg/kg, subcutaneous [SC]) on spontaneous blinking and eye wipe responses were also examined.
RESULTS
Lacrimal gland excision resulted in mechanical hypersensitivity and an increase in spontaneous blinking in the ipsilateral eye over an 8-week period that was more pronounced after infra- and exorbital gland excision. The time spent eye wiping was also enhanced in response to hypertonic saline (5.0 M) at both 1- and 8-week time-points, but only in infra- and exorbital gland excised animals. Morphine attenuated spontaneous blinking, and the response to hypertonic saline in dry eye animals and topical proparacaine application reduced spontaneous blinking down to control levels.
CONCLUSIONS
These results indicate that aqueous tear deficiency produces hypersensitivity in the rat cornea. In addition, the increase in spontaneous blinks and their reduction by morphine and topical anesthesia indicate the presence of persistent irritation elicited by the activation of corneal nociceptors.
Topics: Analgesics, Opioid; Analysis of Variance; Anesthetics, Local; Animals; Blinking; Cornea; Disease Models, Animal; Dry Eye Syndromes; Fluorescein Angiography; Lacrimal Apparatus; Male; Morphine; Propoxycaine; Rats; Rats, Sprague-Dawley; Sensory Thresholds; Tears
PubMed: 26024120
DOI: 10.1167/iovs.15-16717 -
Investigative Ophthalmology & Visual... May 2015Topical anesthetics can reduce episcleral venous pressure (EVP) and IOP in rabbits. In this study, we investigated the effect of topical anesthesia on EVP in normal...
PURPOSE
Topical anesthetics can reduce episcleral venous pressure (EVP) and IOP in rabbits. In this study, we investigated the effect of topical anesthesia on EVP in normal human subjects.
METHODS
We included in this study 30 eyes of 15 healthy volunteers who were habitual soft contact lens wearers. The EVP was measured before and at 5 and 10 minutes after instillation of topical proparacaine 0.5% in one eye. The EVP was measured by using a custom objective venomanometer. We compared EVP at 5 and 10 minutes after proparacaine to EVP before instilling proparacaine.
RESULTS
There was no significant difference between EVP in eyes receiving topical anesthetic at 5 or 10 minutes (7.2 ± 2.2 and 7.6 ± 2.7 mm Hg, respectively; mean ± SD) compared to contralateral eyes (6.9 ± 2.5 and 7.3 ± 2.6 mm Hg, respectively; P > 0.10). As well, EVP was not significantly different 5 or 10 minutes after topical anesthesia compared to baseline in either the eyes receiving anesthetic or the contralateral eyes (all P > 0.10; minimum detectable difference, 1.4-1.9 mm Hg, α = 0.05, β = 0.20, n = 30 eyes).
CONCLUSIONS
The EVP in human eyes is not affected significantly by topical anesthetics.
Topics: Adult; Anesthetics, Local; Female; Healthy Volunteers; Humans; Intraocular Pressure; Male; Manometry; Middle Aged; Propoxycaine; Sclera; Venous Pressure; Young Adult
PubMed: 26024082
DOI: 10.1167/iovs.14-16325 -
Indian Journal of Pediatrics Jan 2016To investigate the efficacy of paracetamol in reducing pain during examination for retinopathy of prematurity (ROP) in preterm infants. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the efficacy of paracetamol in reducing pain during examination for retinopathy of prematurity (ROP) in preterm infants.
METHODS
A total of 114 infants undergoing eye examination for retinopathy of prematurity screening were prospectively randomized. Topical anesthetic (Proparacaine; Alcaine® drop 0.5%) was applied 30 s before the eye examination in all the infants. The infants in the intervention group (Group 1, n = 58) received 15 mg/kg of oral paracetamol, 60 min before the examination. The control group (Group 2, n = 56) received the same volume of sterile water per oral with an opaque syringe. Primary outcome measurement was pain assessed by Premature Infant Pain Profile (PIPP) score. Secondary outcome measurements were tachycardia (>180 bpm)/bradycardia (<100 bpm), desaturations (<85% for >10 s), and crying time.
RESULTS
The groups were similar for gestational age, birthweight or postnatal age at examination. The intervention group had a significantly lower mean PIPP score during eye examination, following insertion of the speculum [Group 1:12 (9-13) vs. Group 2:14 (13-15), p 0.001]. There were no significant differences between the groups with regard to crying time and the number of the patients with tachycardia/bradycardia and desaturation.
CONCLUSIONS
Oral paracetamol modestly reduces pain scores during eye examinations. Further cross-over trials on dose and frequency of paracetamol and combination of pharmacological with non-pharmacological approaches and paracetamol alone as a single agent in significant pain reduction are needed.
Topics: Acetaminophen; Administration, Oral; Analgesics, Non-Narcotic; Anesthetics, Local; Crying; Double-Blind Method; Female; Humans; Infant, Newborn; Infant, Premature; Male; Neonatal Screening; Ophthalmologic Surgical Procedures; Pain; Pain Measurement; Propoxycaine; Retinopathy of Prematurity; Treatment Outcome
PubMed: 25947264
DOI: 10.1007/s12098-015-1765-8 -
Eye (London, England) Aug 2015
Randomized Controlled Trial
Topics: Adult; Anesthetics, Local; Double-Blind Method; Eye Pain; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; Pain Measurement; Propoxycaine; Prospective Studies; Refrigeration; Young Adult
PubMed: 25907208
DOI: 10.1038/eye.2015.59 -
Arquivos Brasileiros de Oftalmologia 2015To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To compare the anesthetic effectiveness of topical proparacaine drops, subconjunctival lidocaine, and 2% lidocaine gel.
METHODS
Ninety-two patients undergoing intravitreal injections were randomized to 1 of 3 groups: proparacaine 0.5% drops (Group Drops), proparacaine 0.5% drops plus subconjunctival lidocaine (Group SC), or 2% lidocaine gel (Group Gel). Patients were asked to score their pain experience using a visual analog scale of 0 to 10 immediately following the injections and 10 min, 1 h, 6 h, and 24 h after the injections. Patients also graded the overall injection experience as Excellent, Very Good, Fair, Poor, or Awful. The physician evaluated the patients' eye movement during intravitreal injection on 3 levels: (0) none or minimal, (1) not compromising the injection, and (2) compromising the injection.
RESULTS
The patients in Group Drops had the worst mean pain scores during the injection and 10 min after, with the highest occurrence of movements compromising the procedure (Grade 2; 38.7%). The patients in Group SC had a higher percentage of good experiences (37.9%) but a higher incidence of chemosis (16.7%). The patients in Group Gel had similar overall pain scores to Group Drops patients but a higher incidence of keratitis (19.4%). There was no statistically significant correlation between the use of aspirin or anticoagulants and the occurrence of hyperemia or hyposphagma.
CONCLUSION
Subconjunctival lidocaine was most effective in preventing pain and eye movements during intravitreal injections. Although 2% lidocaine gel produced a good overall experience for the patients, the incidence of keratitis was very high (19.4%). Therefore, we do not recommend 2% lidocaine gel as the first anesthetic choice for intravitreal injections. There is no evidence to suspend the use of aspirin or other anticoagulants drugs prior to intravitreal injections.
Topics: Adult; Aged; Aged, 80 and over; Anesthesia, Local; Anesthetics, Local; Eye Movements; Female; Humans; Intravitreal Injections; Keratitis; Lidocaine; Macular Degeneration; Macular Edema; Male; Middle Aged; Pain Measurement; Patient Satisfaction; Propoxycaine; Prospective Studies
PubMed: 25714534
DOI: 10.5935/0004-2749.20150008 -
Journal of Tropical Pediatrics Apr 2015To assess the effectiveness of expressed breast milk (EBM) on neonatal pain during screening for retinopathy of prematurity (ROP). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To assess the effectiveness of expressed breast milk (EBM) on neonatal pain during screening for retinopathy of prematurity (ROP).
METHODS
Neonates who were on oral feeds undergoing ROP screening were included. Babies were randomized into intervention group (EBM + Standard practice) and control group. The standard practice is proparacaine, nesting and swaddling. Pain was assessed by PIPP scale, during and at 1 and 5 min after the procedure by the principal investigator who was blinded.
RESULTS
The groups were similar in baseline characteristics. The group receiving EBM had significantly lower PIPP scores during the procedure 12.7 ± 1.69 compared to the control group 15.5 ± 1.78 (p < 0.05). The beneficial effect persisted at 1 min and 5 min after the procedure 6.20 ± 1.9 vs. 12.4 ± 2.54 (p ≤ 0.05) at 1 min; 3.2 ± 1.5 and 6.85 ± 2.4 (p < 0.05) at 5 min.
CONCLUSION
Oral EBM significantly reduces pain during and after ROP screening.
Topics: Anesthetics, Local; Breast Feeding; Double-Blind Method; Female; Humans; Infant, Newborn; Male; Mass Screening; Milk, Human; Outcome Assessment, Health Care; Pain; Pain Measurement; Propoxycaine; Retinopathy of Prematurity; Vision Screening
PubMed: 25541552
DOI: 10.1093/tropej/fmu073