Proxymetacaine hydrochloride

How it works

As an ester local anaesthetic it reversibly blocks neuronal sodium channels in the ocular surface, preventing the generation and conduction of pain impulses.

Prescribing in practice

• Topical ocular anaesthetics must not be supplied for repeated self-administration or to relieve pain, as repeated use causes corneal epithelial toxicity, delayed healing and can lead to severe sight-threatening keratopathy.
• Because the cornea is anaesthetised and the protective blink reflex is abolished, the eye should be protected until sensation returns.
• Use with care in patients with known sensitivity to ester-type local anaesthetics.

Monitoring

Monitoring is clinical and procedure-based; ensure the corneal surface is intact and protected until anaesthesia resolves.

Counselling the patient

• Your eye will be numb for a short period; do not rub it until normal feeling returns.
• Keep the eye protected and avoid getting anything in it while numb.
• These drops are for clinical use only and must never be used to self-treat eye pain at home.

Evidence & guidelines

Topical ocular anaesthetics are standard for ophthalmic procedures, with MHRA and SPC guidance warning against unsupervised repeated use.