PROPARACAINE EYE DROPS
Alternative Treatments for Facial Neuralgias

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| Medical References | Personal Experiences | Personal Opinions |

Anesthetic Eye Drops

Anesthetic eye drops (specifically Proparacaine) are reported to have been used to give short-term relief from some cases of TN pain. Proparacaine is a local anesthetic, which anesthetizes the eye and possibly the nerves around it. It is thus in theory possible that it may provide some short-term relief for some cases of TN, particularly those in which one of the upper two
branches is affected.

A newer study suggests that the treatment is almost certainly ineffective for classical TN pain. Although otherwise relatively harmless, Proparacaine may damage the eye if used extensively, so that it cannot be considered a long-term treatment. The possibility is included here mainly for completeness and for curiosity value. In addition, we do not know whether anesthetic eyedrops have been tried in the treatment of atypical forms of TN.

Medical References.
This information is extracted from a paper in the J.Neurosurg Volume 77/ July 1992. Two drops of an eye anesthetic agent (0.5% proparacaine hydrochloride) instilled for ophthamological examination prior to cataract removal yeilded lasting relief of symptoms of trigeminal neuralgia. This relief is belived to be best on V1 division of the trigeminal nerve. V1 is the section of the nerve that has triggers in the upper face. They report that 15 out of 25 patients were helped.

[Zavon and Fichte, 1991] discovered the possibility of using eye anesthetics by accident. One of them (Zavon), himself suffering from TN, found that his TN pain vanished for over a year immediately after an eye anesthetic was applied. The doctors then tested the anesthetic on another TN patient, and obtained pain relief for over a month. Since this was only a case study, no general conclusions can be drawn. [Flach, 1991] noted with regard to the original study that repeated use of eye anesthetics may cause toxic keratopathy, and may also slow down the healing of eye wounds. Eye anesthetics must therefore be used with great care, if they are tried.

At least one double-blind placebo-controlled study has been made (Kondziolka et al, 1994), and that study found that a single application of an eyedrop anesthetic does not cause any statistically significant pain relief in the case of classical TN.

• Flach A.J. Trigeminal neuralgia relieved by optical anesthesia. JAMA 1991 Sep 25;266(12):1649
• Kondziolka D, Lemley T, Kestle JR, Lunsford LD, Fromm GH, Jannetta PJ. The effect of single-application topical ophthalmic anesthesia in patients with trigeminal neuralgia. A randomized double-blind placebo-controlled trial. J Neurosurg 1994 Jun;80(6):993-7
• Zavon MR, Fichte CM. Trigeminal neuralgia relieved by ophthalmic anesthetic. JAMA 1991 Jun 5;265(21):2807

Personal Experiences

"I used the Proparacaine HCI solution .5%, two drops, twice a day  (sometimes 3x) for almost a year---with GREAT success. Within a few minutes of putting the drops in my eye, I could taste them in my mouth, so I could see how they might get to the nerve and affect it also. It didn't keep the TN completely at bay, but sure did a number on the bad stuff ! When I brought it up at the conference, I was asked if I was aware that what I had been taking was an overdose?? It may have been---but if it was, I didn't know about it .. My GP gave me a perscription (these drops have to be kept refrigerated )--he said, whatever might work..... " - anonymous

Personal Opinions
(Disclaimer: this section contains purely personal and subjective opinions by individual members of the FNR team. This section must not be considered advice).

"The fact that eyedrops seem to work no better than a placebo may simply illustrate the power of the placebo effect. On the other hand, the fact that some people have reported relief may mean that the treatment is not entirely worthless. In particular, a patient with difficult atypical pain would probably have very little to lose by trying this out." (Jakke Mäkelä)