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It is a common practice to use topical anaesthetic drops to provide temporary relief and aid in the examination of the eyes when strong blepharospasm precludes thorough examination. Ophthalmology departments usually have several types of these—for example, amethocaine, oxybuprocaine (benoxinate), and proxymetacaine. The duration and degree of discomfort caused by amethocaine is significantly higher than proxymetacaine,1,2 whilst the difference in the discomfort between amethocaine and oxybuprocaine is minimal.2 When dealing with children, therefore, it is recommended to use proxymetacaine drops.1
It was my experience that Accident & Emergency (A&E) departments tend to have less choice of these drops. This survey was done to find out the availability of different anaesthetic drops, and the preference for paediatric use given a choice of the above three. Questionnaires were sent to 40 A&E departments across south east England. Thirty nine replied back, of which one department did not see any eye casualties. None of the 38 departments had proxymetacaine. Twenty units had amethocaine alone and 10 units had oxybuprocaine alone. For paediatric use, these units were happy to use whatever drops were available within the unit. Eight units stocked amethocaine and oxybuprocaine, four of these were happy to use either of them on children and four used only oxybuprocaine. One of the latter preferred proxymetacaine but had to contend with oxybuprocaine due to cost issues.
Children are apprehensive about the instillation of any eye drops. Hence, it is desirable to use the least discomforting drops like proxymetacaine. For eye casualties, in majority of District General Hospitals, A&E departments are the first port of call. Hence, A&E units need to be aware of the benefit of proxymetacaine and stock them for paediatric use.