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Tetracaine (Ophthalmic)

Medically reviewed by Last updated on Aug 9, 2020.


(TET ra kane)

Index Terms

  • Amethocaine Hydrochloride
  • Tetracaine HCl
  • Tetracaine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Ophthalmic, as hydrochloride:

Altacaine: 0.5% (12 ea, 15 mL [DSC], 30 mL)

Tetcaine: 0.5% (15 mL [DSC]) [contains chlorobutanol (chlorobutol), edetate disodium]

TetraVisc: 0.5% (12 ea [DSC], 5 mL [DSC]) [contains benzalkonium chloride]

TetraVisc Forte: 0.5% (12 ea [DSC], 5 mL [DSC]) [contains benzalkonium chloride, edetate disodium]

Generic: 0.5% (1 mL, 2 mL [DSC], 4 mL, 5 mL, 15 mL)

Brand Names: U.S.

  • Altacaine
  • Tetcaine [DSC]
  • TetraVisc Forte [DSC]
  • TetraVisc [DSC]

Pharmacologic Category

  • Local Anesthetic
  • Local Anesthetic, Ophthalmic


Ester local anesthetic blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium, potassium, and other ions, which results in inhibition of depolarization with resultant blockade of conduction


Hepatic; detoxified by plasma esterases to aminobenzoic acid



Onset of Action

Anesthetic: Within 30 seconds

Duration of Action

10 to 20 minutes

Use: Labeled Indications

Anesthesia, ocular: Local anesthesia for various ophthalmic procedures requiring rapid, short-acting topical anesthesia, including tonometry, gonioscopy removal of corneal foreign bodies, conjunctival scraping for diagnostic purposes, suture removal from the cornea or conjunctiva, and other short corneal and conjunctival procedures.


Hypersensitivity to tetracaine or any component of the formulation.

Dosing: Adult

Anesthesia, ocular: Ophthalmic: Instill 1 to 2 drops in affected eye(s) as needed. For tonometry and other procedures of short duration, instill just prior to evaluation. For minor surgical procedures, instill every 5 to 10 minutes for up to a maximum of 3 doses. For prolonged anesthesia, instill every 5 to 10 minutes for up to a maximum of 5 doses.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Note: Approval in pediatric patients may vary by products; refer to product-specific labeling.

Ophthalmic anesthesia: Infants, Children, and Adolescents: Ophthalmic solution: Instill 1 drop as needed. Note: In adult patients, doses are separated by 5 to 10 minutes and the maximum number of doses (3 to 5 doses) is dependent on procedure length; fewer doses may be required in young infants; instill initial drop just prior to procedure/evaluation (Anniger 2007; Kliegman 2020; manufacturer's labeling).


Ophthalmic: For topical ophthalmic use only; not for injection or intraocular use. Do not use intracamerally (may lead to damage of the corneal endothelial cells). To avoid contamination, do not touch dropper tip to any surface. Instruct patient to avoid touching eye for 10 to 20 minutes following administration.


Store at room temperature. Protect from light; keep container closed tightly.

Drug Interactions

Bupivacaine: Local Anesthetics may enhance the adverse/toxic effect of Bupivacaine. Management: Avoid using any additional local anesthetics within 96 hours after insertion of the bupivacaine implant (Xaracoll). Monitor therapy

Methemoglobinemia Associated Agents: May enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Monitor therapy

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined: Ophthalmic: Chemosis, conjunctival erythema (transient), lacrimation, photophobia, transient burning or stinging in the eyes

<1%, postmarketing, and/or case reports: Hypersensitivity reaction (corneal)


Concerns related to adverse effects:

• Hypersensitivity: Immediate type allergic corneal reactions, characterized by epithelial keratitis/filament formation, necrotic epithelium sloughing, stromal edema, descemetitis, and iritis, have been reported rarely. Use with caution in patients with known allergies; if signs of sensitivity develop, discontinue use.

Disease-related concerns:

• Cardiac disease: Use with caution in patients with cardiac disease.

Special populations:

• Contact lens wearers: Some formulations may contain benzalkonium chloride, which may be adsorbed by soft contact lenses; remove contacts prior to administration and wait at least 15 minutes before reinserting.

Other warnings/precautions:

• Administration: For topical ophthalmic use only; not for injection or intraocular use. Do not use intracamerally (may lead to damage of the corneal endothelial cells). The anesthetized eye should be protected from irritation, foreign bodies, and rubbing to prevent inadvertent damage.

• Prolonged use: Prolonged and continuous use is not recommended (diminished duration of anesthesia, delayed healing, and severe keratitis may occur). Prolonged use or abuse may also lead to corneal epithelial toxicity, manifesting as epithelial defects, which may progress to permanent corneal damage.

Pregnancy Risk Factor C Pregnancy Considerations

Animal reproduction studies have not been conducted.

Patient Education

What is this drug used for?

• It is used to numb the eye.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Burning

• Stinging

• Redness

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Vision changes

• Eye pain

• Severe eye irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.