Randomised prospective masked study comparing patient comfort following the instillation of topical proxymetacaine and amethocaine

AIMS

To evaluate the claim that topical proxymetacaine produces little or no discomfort on instillation by comparing it against topical amethocaine.

METHODS

This randomised, masked, double blind, prospective study involved 53 consecutive patients. Each patient received one drop of amethocaine 0.5% in one eye and one drop of proxymetacaine 0.5% in the other. The duration of the stinging sensation and degree of discomfort (using descriptive and a linear analogue method) for each topical anaesthetic was assessed.

RESULTS

The mean duration of stinging was 3.2 seconds for proxymetacaine and 22.1 seconds for amethocaine the difference being statistical significant (p < 0.001). The mean descriptive discomfort score was 2.6 for proxymetacaine and 14.2 for amethocaine (p = 0.01). The mean linear analogue score was 5.8 for proxymetacaine and 35.6 for amethocaine (p < 0.001). Proxymetacaine had a successful tonometry rate of 93% and amethocaine 98%.

CONCLUSION

This clinical study confirms that proxymetacaine is more comfortable on instillation than amethocaine. Minimising unnecessary patient discomfort is not only ideal, but encourages cooperation in apprehensive patients especially in children.

Efficacy of probing as treatment of epiphora in adults with blocked nasolacrimal ducts

AIMS

To determine the efficacy of probing in the initial treatment of epiphora and the symptom free period in adults with blocked nasolacrimal ducts.

METHODS

The results of probing in 85 eyes with epiphora due to nasolacrimal duct obstruction were studied retrospectively after a mean follow up of 7.4 months (SD 11.6) by a questionnaire and interview survey of patients.

RESULTS

35% of the eyes had an outcome of no watering after probing, 17% mild watering, 35% moderate watering, and 11% severe watering. The patients' satisfaction (watering subjectively improved) after undergoing this procedure was 82%, which is higher than previously reported. The mean symptom free period in eyes with no watering was 11.25 months, in eyes with mild watering 8.20 months, in eyes with moderate watering 5.35 months, and in eyes with severe watering 0.95 months. There was a significant difference (p = 0.001) in the symptom free period between the no watering and severe watering groups.

CONCLUSIONS

Probing in adults with confirmed nasolacrimal duct obstruction can be recommended as an initial treatment procedure because of its relatively good efficacy and high patient satisfaction without compromising subsequent surgical treatment if unsuccessful.

Ophthalmic pain following cataract surgery: a comparison between local and general anaesthesia

Ophthalmic pain following uncomplicated extracapsular cataract surgery was assessed postoperatively in 61 patients; 55% undergoing ophthalmic surgery had no pain or discomfort postoperatively, and 32% reported slight discomfort. Approximately 8% of patients reported mild pain and the remaining 5% experienced moderate to severe pain. Local anaesthesia was shown to be more comfortable postoperatively than general anaesthesia in the immediate postoperative period with both groups receiving similar amounts of postoperative analgesics.