Drug reference

proparacaine

Topical ophthalmic ester local anaesthetic · Ophthalmic local anesthetic

START

1–2 drops of 0.5% in eye before procedure

TYPICAL MAX

Topical procedural use only — NEVER for home/chronic ocular pain

STOP IF

Allergic reaction or corneal toxicity signs

WATCH

Restrict to in-clinic use; corneal abuse keratopathy with self-administration

CDSCO approvedATC S01HA04

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 18s · 10-20 s
PEAK: 1min · ~1 min
t½: 36s · esterase
DURATION: 18min · 15-20 min

EXCRETION

Renal — PABA metabolite

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Topical use generally acceptable.

FDA category + note

Mechanism

Ester-type local anaesthetic that reversibly blocks voltage-gated sodium channels in corneal / conjunctival sensory neurons, providing rapid and brief topical anaesthesia for ophthalmic examination and minor procedures.

Indications

Topical anaesthesia for ophthalmic examination, tonometry, foreign-body removal, suture removal, minor corneal procedures

Dosing

Adult: 1–2 drops of 0.5% in eye(s) before procedure; for prolonged anaesthesia: 1 drop every 5–10 min for 5–7 doses.
Pediatric: Same as adult.
Renal adjustment: No adjustment (topical).
Hepatic adjustment: No adjustment.
Geriatric: Standard topical use.
Max dose: Topical use only — do NOT prescribe for home pain management (corneal toxicity)

Pharmacokinetics

Onset

~10–20 s

Peak effect

~1 min

Duration

~15–20 min (single drop)

Half-life

Not applicable (topical; rapid ester hydrolysis)

Bioavailability

Negligible systemic

Protein binding

Not relevant

Metabolism

Plasma cholinesterase hydrolysis (rapid)

Excretion

Renal (PABA metabolite)

Contraindications

Severe hypersensitivity to ester anaesthetics
Caution: sulfonamide allergy (PABA cross-reaction)

Side effects

Common

Brief stinging on instillationTransient mild corneal irritationReflex tearing

Serious

Severe corneal epithelial toxicity / 'topical-anaesthetic abuse keratopathy' with repeated dosing
Severe hypersensitivity / contact dermatitis
Allergic conjunctivitis (delayed type)