Antibacterial activity of preservative-free topical anesthetic drops in current use in ophthalmology departments

Cornea. 2009 Jan;28(1):58-61. doi: 10.1097/ICO.0b013e318182ecf9.


Aim: The antibacterial effect of topical anesthetics may lead to false-negative cultures from corneal specimens of bacterial keratitis. This in vitro study compared the antibacterial effect of 3 unpreserved topical anesthetics to indicate the most appropriate agent for corneal scrapes.

Methods: Four bacterial strains (Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pneumoniae) derived from the most frequently isolated microorganisms from corneal ulcers were cultured from stored control stocks and clinical specimens. These strains were used to determine the minimum inhibitory concentration (MIC) of 3 preservative-free anesthetic eyedrops: proxymetacaine 0.5%, oxybuprocaine 0.4%, and tetracaine 1%.

Results: There was no inhibition of growth seen with proxymetacaine 0.5% (5000 microg/mL) with any of the organisms except S. epidermidis, which demonstrated an MIC of 2500 microg/mL (equivalent to a dilution of (1/2)). Tetracaine 1% (10,000 microg/mL) produced an MIC ranging between 625 and 1250 microg/mL, inhibiting all 4 strains at the commercially available dilution. Oxybuprocaine 0.4% (4000 microg/mL) resulted to be the second most inhibitory preparation with an MIC ranging between 1000 and 2000 microg/mL.

Conclusions: Currently used preservative-free topical anesthetics differ in bacterial growth inhibition. This in vitro study showed that proxymetacaine 0.5% is the least inhibitory on bacterial growth and therefore the most appropriate to be used before corneal scrapes.

Publication types

  • Comparative Study

MeSH terms

  • Anesthetics, Local / administration & dosage
  • Anesthetics, Local / pharmacology
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / pharmacology*
  • Bacterial Infections / diagnosis
  • Cornea* / microbiology
  • Drug Utilization*
  • False Negative Reactions
  • Hospital Departments* / trends
  • Humans
  • In Vitro Techniques
  • Keratitis / microbiology
  • Microbial Sensitivity Tests
  • Ophthalmic Solutions
  • Ophthalmology* / trends
  • Preservatives, Pharmaceutical
  • Procaine / analogs & derivatives
  • Procaine / pharmacology
  • Propoxycaine / pharmacology
  • Specimen Handling / methods*
  • Tetracaine / pharmacology


  • Anesthetics, Local
  • Anti-Bacterial Agents
  • Ophthalmic Solutions
  • Preservatives, Pharmaceutical
  • Tetracaine
  • Procaine
  • benoxinate
  • proxymetacaine
  • Propoxycaine