Tetracaine (Ophthalmic)
Tetracaine hydrochloride
Brand names:Pontocaine, Altacaine, Tetcaine
An ester-type topical ocular anesthetic, functionally equivalent to proparacaine for tactical EMS use. Tetracaine has slightly longer duration but more pronounced stinging on instillation. Choice between tetracaine and proparacaine is typically driven by availability. Same caution applies: never dispense for patient self-administration.
Pharmacology and Actions
Tetracaine is an ester-type topical local anesthetic that blocks voltage-gated sodium channels on corneal and conjunctival sensory nerve endings. Slightly more potent and longer-acting than proparacaine but more likely to cause initial stinging on instillation. Rapidly hydrolyzed by plasma and tissue cholinesterases.
Indications
- Topical ocular anesthesia for foreign body removal
- Topical anesthesia for tonometry, gonioscopy, and ocular procedures
- Suture removal from cornea or conjunctiva
- Adjunct for ocular examination of painful or photophobic eye
Absolute Contraindications
- Known hypersensitivity to tetracaine or ester anesthetics
- Penetrating eye injury (mask of symptoms)
Precautions and Side Effects
Common: stinging or burning on instillation (more pronounced than proparacaine, lasts 15 to 30 seconds). Allergic conjunctivitis with cross-reactivity to other ester anesthetics including procaine and benzocaine. With repeated use: corneal toxicity, delayed healing, ring infiltrates. No clinically significant systemic interactions when used topically at recommended doses. Sulfonamide antimicrobial efficacy may be reduced when combined with ester anesthetics - rarely clinically relevant for short-term ophthalmic use. Pregnancy Category C. Minimal systemic absorption; considered compatible with lactation. Standard pediatric and elderly dosing.
Adult Dosing
Pediatric Dosing
Same as adult dosing: 1 to 2 drops of 0.5 percent solution.
Pharmacokinetics
Peak Effect: 1 to 2 minutes.
Duration: 10 to 20 minutes.
Storage and Handling
Refrigerate (2 to 8 degrees C) or store at room temperature per labeling. Protect from light. Discard if solution becomes discolored.
Reconstitution:
Available as 0.5 percent ophthalmic solution. No reconstitution required.
TCCC and TECC Role
Tetracaine is not in the TCCC core formulary. Functionally equivalent to proparacaine for tactical EMS use - ocular foreign body removal, painful eye exam, fluorescein staining setup. The choice between tetracaine and proparacaine is typically driven by what is on hand. Mission impact is minor; functional recovery within 20 to 30 minutes.
If you have proparacaine, use proparacaine - it stings less and patients tolerate it better. Tetracaine is the standard if proparacaine is unavailable. Operationally the workflow is identical: one drop, allow 30 seconds for onset, examine, fluorescein stain, identify and address the corneal problem, then patch or shield if needed. Document the use carefully; never dispense the bottle for repeated patient use.
Same as proparacaine: dispensing the bottle for repeated self-administration causes severe corneal injury. The other mistake unique to tetracaine is warning the patient inadequately about the burning sensation on instillation - the burn is brief but distressing, and a startled patient with their head jerking is a setup for additional eye injury. Counsel the patient before instillation.
This drug profile is provided as educational reference material for trained medical providers. It is not medical advice, not a substitute for formal training, and not a substitute for current published guidelines or medical direction.
Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances are subject to additional handling, accountability, and documentation requirements per DEA and state law. Always verify dosing, indications, contraindications, and route of administration against current published guidelines and your local protocols before administration.
If this content is being viewed during a medical emergency, call 911 immediately and follow the direction of your local emergency dispatch and medical control. Do not use this reference as a substitute for emergency medical services.
Drug information evolves. Last reviewed dates and source citations are provided for each entry. Confirm currency against the cited source before clinical use.
Penn Tactical Solutions publishes this reference for educational purposes. PTS does not provide medical direction and does not assume responsibility for clinical decisions made in the field. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Educational reference for trained medical providers. Not medical advice. Not a substitute for formal training, current published guidelines, or medical direction. Drug administration is governed by your scope of practice, agency standing orders, medical director protocols, and applicable state and federal regulations. Controlled substances require additional storage, accountability, and documentation per DEA and state law.
In a medical emergency, call 911. This reference is not a substitute for emergency medical services.
Verify dosing, indications, and contraindications against current published guidelines and your local protocols before administration. Confirm content currency against the source citation. Penn Tactical Solutions does not provide medical direction. Clinical responsibility rests with the administering provider, their medical director, and their agency.
Tetracaine (Ophthalmic)
| IV/IO | None (None) |
| IM | None (None) |
| IN | None (None) |
| PO | None (None) |