Oxibuprocaine Bausch & Lomb
Oxybuprocaine hydrochloride — topical ophthalmic local anesthetic
Quick facts about Oxibuprocaine Bausch & Lomb
Key takeaways about Oxibuprocaine
- Healthcare professional use only: This medication is administered by eye care specialists during clinical examinations and minor ophthalmic procedures
- Rapid onset and short duration: Numbs the eye surface within 20–30 seconds, with the effect lasting approximately 15–20 minutes
- Avoid prolonged use: Extended or repeated application can damage the cornea; it is strictly intended for single-procedure use
- Protect your eyes after use: The eye has reduced sensation while anesthetized — avoid touching or rubbing, and protect from foreign particles
- Do not drive immediately: Temporary blurred vision may occur; wait until your vision returns to normal before driving or operating machinery
What Is Oxibuprocaine Bausch & Lomb and What Is It Used For?
Oxibuprocaine Bausch & Lomb is a local anesthetic eye drop containing oxybuprocaine hydrochloride 0.4%. It is used to numb the surface of the eye for ophthalmic examinations and minor procedures, such as measuring intraocular pressure (tonometry), removing foreign bodies from the eye, and fitting contact lenses.
Oxybuprocaine (also known internationally as benoxinate) belongs to the ester class of local anesthetics. When instilled into the eye, it blocks nerve conduction in the corneal and conjunctival nerve endings by inhibiting voltage-gated sodium channels. This reversible blockade prevents the generation and propagation of pain signals, producing a rapid and reliable surface anesthesia that is ideal for short ophthalmic procedures.
The medication is manufactured by Bausch + Lomb Ireland Limited and supplied in preservative-free single-dose containers, each holding 0.5 ml of solution. The single-dose format eliminates the need for preservatives, which reduces the risk of chemical irritation and allergic reactions to preservative agents such as benzalkonium chloride. Each container is individually sealed in a protective outer pouch to shield the solution from light degradation.
In clinical ophthalmology, oxybuprocaine is one of the most widely used topical anesthetics worldwide. It is favored over some other ophthalmic anesthetics (such as tetracaine) because it tends to produce less initial stinging upon instillation, making it better tolerated by patients. Studies published in the British Journal of Ophthalmology have confirmed that oxybuprocaine 0.4% provides effective corneal anesthesia comparable to proparacaine 0.5%, with a similar safety profile for routine diagnostic use.
Common clinical indications for oxybuprocaine include:
- Tonometry: Measurement of intraocular pressure, essential for screening and monitoring glaucoma
- Gonioscopy: Examination of the drainage angle of the eye using a special lens placed on the cornea
- Foreign body removal: Numbing the eye to allow safe extraction of embedded particles from the cornea or conjunctiva
- Contact lens fitting: Reducing discomfort during trial fitting of hard or rigid gas-permeable contact lenses
- Electroretinography (ERG): Placing recording electrodes on the cornea for retinal function testing
- Minor surgical procedures: Providing surface anesthesia for procedures such as conjunctival scraping or pterygium assessment
Oxibuprocaine is intended for professional clinical use only. It should never be used for self-medication at home. Unsupervised or repeated use can lead to serious corneal damage, delayed wound healing, and potentially permanent vision problems. If you are experiencing eye pain, consult an ophthalmologist rather than attempting self-treatment with anesthetic drops.
What Should You Know Before Using Oxibuprocaine?
Before receiving oxibuprocaine eye drops, inform your healthcare provider about any known allergies to local anesthetics (especially ester-type agents), current medications, and whether you are pregnant or breastfeeding. Oxibuprocaine should not be used if you are allergic to oxybuprocaine hydrochloride or any of the other ingredients.
Contraindications
The primary contraindication for oxybuprocaine is a known hypersensitivity (allergy) to oxybuprocaine hydrochloride or to any of the excipients in the formulation. Patients with a documented allergy to other ester-type local anesthetics (such as procaine, tetracaine, or benzocaine) may have cross-reactivity and should inform their healthcare provider before the procedure.
Unlike amide-type local anesthetics (such as lidocaine or bupivacaine), ester-type agents like oxybuprocaine are metabolized by plasma cholinesterases and may produce para-aminobenzoic acid (PABA) as a metabolite. PABA is known to be a common allergen, which explains why ester-type anesthetic allergies, though uncommon, are more frequently reported than amide-type allergies. Patients with a known sensitivity to PABA or PABA-containing products (some sunscreens and cosmetics) should exercise caution.
Warnings and Precautions
Several important warnings and precautions apply to the use of oxybuprocaine eye drops:
- Corneal damage risk: Prolonged or repeated use of topical ophthalmic anesthetics can cause significant damage to the corneal epithelium, including epithelial erosion, stromal opacification, and in severe cases, corneal perforation. This medication should only be used for the minimum number of applications required for the intended procedure.
- Reduced corneal sensation: While the eye is anesthetized, the normal protective blink reflex and pain sensation are diminished. Patients must be instructed to avoid touching their eyes and to protect them from foreign particles, dust, and physical trauma during the period of anesthesia.
- Allergic and anaphylactic reactions: Although rare, severe allergic reactions including anaphylaxis have been reported with topical ophthalmic anesthetics. Seek immediate medical attention if symptoms such as swelling, rash, hives, difficulty breathing, chills, hot flushes, headache, nausea, rapid heart rate, or low blood pressure occur.
- Contact lens wear: Contact lenses should be removed before administration of oxybuprocaine. Patients should wait until the anesthetic effect has fully worn off and any residual eye drops have been naturally cleared before reinserting contact lenses.
Pregnancy and Breastfeeding
Oxibuprocaine Bausch & Lomb can be used during pregnancy and breastfeeding according to the approved prescribing information. When applied topically to the eye in the small quantities used for diagnostic procedures, systemic absorption is minimal. The brief duration of action and the low volume administered (1–2 drops) mean that clinically significant blood levels are not expected to occur.
Nevertheless, as with all medications during pregnancy and breastfeeding, the decision to use oxybuprocaine should be made by a qualified healthcare professional who can weigh the clinical necessity of the ophthalmic examination against any theoretical risk. The European Medicines Agency (EMA) classifies the systemic exposure from single-use ophthalmic anesthetics as negligible.
Driving and Operating Machinery
Oxibuprocaine can cause temporary blurred vision following instillation. Patients should not drive or operate machinery until their vision has returned to normal. The visual disturbance typically resolves within 15–30 minutes, but individual responses may vary. It is advisable to arrange alternative transportation if you anticipate receiving these eye drops during an appointment.
How Does Oxibuprocaine Interact with Other Drugs?
Oxybuprocaine has a known interaction with sulfonamide antibiotics — it can reduce their antibacterial effectiveness. Because this medication is applied topically to the eye by healthcare professionals, systemic drug interactions are generally minimal.
The pharmacological interactions of topical ophthalmic anesthetics are limited compared to systemically administered drugs, owing to the very small quantities absorbed into the bloodstream. However, some clinically relevant interactions should be noted by healthcare professionals administering this medication.
The most significant known interaction is with sulfonamide antibiotics. Ester-type local anesthetics such as oxybuprocaine are hydrolyzed by plasma cholinesterases to produce PABA (para-aminobenzoic acid) as a metabolite. PABA directly antagonizes the mechanism of action of sulfonamide antibiotics, which work by competitively inhibiting the bacterial enzyme dihydropteroate synthase — an enzyme that normally uses PABA as a substrate. When oxybuprocaine metabolites increase local PABA concentrations, the effectiveness of sulfonamide antibiotics may be reduced.
| Interacting Drug | Type | Effect | Clinical Significance |
|---|---|---|---|
| Sulfonamide antibiotics (e.g., sulfacetamide) | Pharmacodynamic | Reduced antibacterial efficacy of sulfonamides | Moderate — avoid concurrent ophthalmic use |
| Other topical ophthalmic anesthetics | Additive | Increased risk of corneal epithelial toxicity | Moderate — minimize total anesthetic exposure |
| Cholinesterase inhibitors (e.g., echothiophate) | Pharmacokinetic | Prolonged anesthetic effect (slower metabolism) | Low — monitor for extended numbness |
Always inform your healthcare provider about all medications you are currently using, including prescription drugs, over-the-counter medicines, and herbal supplements. Although the systemic absorption of topical oxybuprocaine is minimal, providing a complete medication history helps ensure the safest and most effective care during your ophthalmic examination.
What Is the Correct Dosage of Oxibuprocaine?
Oxibuprocaine is administered by healthcare professionals only. The typical dose is 1–2 drops for tonometry, or 1 drop repeated 3–4 times at 30-second intervals for procedures requiring deeper anesthesia such as foreign body removal.
Oxibuprocaine Bausch & Lomb is not a medication that patients self-administer. It is instilled into the eye by trained healthcare professionals in clinical settings. The dosage varies depending on the type of procedure being performed and the depth of anesthesia required.
Tonometry (Intraocular Pressure Measurement)
Dose: 1–2 drops instilled into the conjunctival sac of the affected eye(s).
Onset: Approximately 20–30 seconds.
Duration: Sufficient anesthesia for the brief tonometry procedure (typically 15–20 minutes).
Foreign Body Removal / Contact Lens Fitting / Minor Procedures
Dose: 1 drop instilled 3–4 times at approximately 30-second intervals.
Rationale: Multiple applications allow deeper and more prolonged corneal anesthesia required for these procedures.
Duration: Provides adequate working time for most minor procedures.
| Procedure | Dose | Frequency | Notes |
|---|---|---|---|
| Tonometry | 1–2 drops | Single application | Wait 20–30 seconds for onset |
| Foreign body removal | 1 drop | 3–4 times, 30 sec apart | Deeper anesthesia achieved |
| Contact lens fitting | 1 drop | 3–4 times, 30 sec apart | For rigid/hard lenses |
| Gonioscopy / ERG | 1–2 drops | As clinically indicated | May repeat if extended procedure |
Pediatric Use
Oxybuprocaine 0.4% eye drops can be used in pediatric patients for ophthalmic examinations and procedures. The dosing is generally the same as for adults. However, care should be taken in very young children and infants, as they are unable to protect their eyes from trauma during the period of anesthesia. A parent or caregiver should be present and instructed to prevent the child from rubbing their eyes. Healthcare professionals should use the minimum dose necessary to achieve adequate anesthesia.
Elderly Patients
No specific dose adjustment is required for elderly patients. However, clinicians should be aware that elderly patients may have pre-existing corneal conditions (such as dry eye disease or corneal dystrophies) that could theoretically increase susceptibility to epithelial damage from topical anesthetics. The minimum effective dose should be used.
Overdose
Given that oxybuprocaine is administered by healthcare professionals in controlled clinical settings, overdose is uncommon. However, if excessive amounts are inadvertently applied to the eye, or if the solution is accidentally ingested (particularly by children), medical advice should be sought immediately. Contact your local poison control center or emergency department for guidance.
Symptoms of systemic toxicity from local anesthetics (though extremely unlikely with topical ophthalmic use) may include central nervous system effects such as restlessness, tremors, and convulsions, followed by cardiovascular depression including bradycardia and hypotension. Treatment is supportive and symptomatic.
If a child or adult accidentally swallows oxybuprocaine eye drops, contact your local emergency services or poison control center immediately. Do not induce vomiting unless instructed by a medical professional. Bring the medication packaging with you to assist healthcare providers in determining the quantity ingested.
What Are the Side Effects of Oxibuprocaine?
The most common side effects are temporary stinging or burning upon instillation and local eye irritation. Corneal damage can occur with repeated use. Rare systemic effects include tremors, blurred vision, slow heart rate, and low blood pressure. Seek immediate medical help if you experience signs of a severe allergic reaction.
Like all medicines, oxybuprocaine can cause side effects, although not everyone experiences them. Most side effects are local (affecting the eye) and transient, resolving quickly after the anesthetic effect wears off. Systemic side effects are rare because the amount of drug absorbed into the bloodstream from topical ophthalmic application is very small.
Contact your healthcare provider immediately if you experience any of the following: swelling of the face, lips, or throat; widespread rash or hives; difficulty breathing; chills; hot flushes; headache; general feeling of being unwell; nausea; restlessness; rapid heart rate; or low blood pressure. These may be signs of a serious allergic or anaphylactic reaction (frequency unknown).
Common Side Effects
May affect up to 1 in 10 people
- Temporary stinging or burning sensation upon instillation
- Local irritation of the eye
- Corneal epithelial damage with repeated use
Rare Side Effects
May affect up to 1 in 1,000 people
- Tremors
- Blurred vision
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Dizziness
Reported Side Effects
Frequency not known (cannot be estimated from available data)
- Ocular allergy (itchy, red, irritated, watery eyes; burning or stinging)
- Allergic blepharitis (inflammation of the eyelids with redness, swelling, scaling, and crusting at the lash line)
- Photophobia (increased light sensitivity)
- Anaphylactic/anaphylactoid reactions (see warning above)
The initial stinging sensation upon application is considered a normal pharmacological response and typically subsides within a few seconds as the anesthetic takes effect. This brief discomfort should be distinguished from a true allergic reaction, which would present with persistent symptoms such as redness, swelling, and itching that worsen rather than improve.
The most clinically significant risk associated with oxybuprocaine is corneal epithelial toxicity from repeated or prolonged use. Research published in Cornea journal has demonstrated that even a few days of repeated topical anesthetic use can lead to corneal epithelial cell death, delayed wound healing, stromal infiltration, and in extreme cases, corneal perforation requiring surgical intervention. This is why oxybuprocaine is strictly intended for single-procedure use under healthcare professional supervision and is never prescribed for ongoing pain management.
Reporting Side Effects
Reporting suspected side effects after a medicine has been authorized is important. It allows ongoing monitoring of the medicine's benefit-risk balance. Healthcare professionals and patients are encouraged to report any suspected adverse reactions to their national pharmacovigilance authority (e.g., the Medicines and Healthcare products Regulatory Agency in the UK, the European Medicines Agency in the EU, or the FDA MedWatch program in the United States).
How Should You Store Oxibuprocaine Bausch & Lomb?
Store at or below 25°C (77°F). Do not freeze. Keep in the original packaging to protect from light. Keep out of the reach and sight of children. Do not use after the expiry date printed on the packaging.
Proper storage of oxybuprocaine is essential to maintain the chemical stability and sterility of the solution. The following storage guidelines should be observed:
- Temperature: Store at or below 25°C (77°F). The solution should not be exposed to excessive heat, as elevated temperatures can accelerate degradation of the active ingredient and excipients.
- Freezing: Do not freeze. Freezing can alter the physicochemical properties of the solution, potentially affecting its efficacy and tolerability.
- Light protection: Store in the original packaging. Oxybuprocaine hydrochloride is light-sensitive, and exposure to ambient light can lead to photodegradation of the active compound, reducing potency.
- Expiry date: Do not use after the expiry date stated on the carton and container label. The expiry date refers to the last day of the stated month.
- Single-use containers: Each single-dose container should be used immediately after opening. Any unused solution remaining in the container should be discarded. Do not store opened containers for later use, as sterility cannot be guaranteed once the seal is broken.
- Child safety: Keep out of the sight and reach of children at all times.
Medicines should not be disposed of via household waste or down the drain. Ask your pharmacist how to dispose of medicines that are no longer needed. These measures help to protect the environment and prevent accidental exposure.
What Does Oxibuprocaine Bausch & Lomb Contain?
The active substance is oxybuprocaine hydrochloride 4 mg/ml (0.4%). The other ingredients are hydrochloric acid (for pH adjustment) and purified water. The product is preservative-free.
Oxibuprocaine Bausch & Lomb has a deliberately simple formulation designed to minimize the risk of irritation and allergic reactions:
- Active substance: Oxybuprocaine hydrochloride 4 mg/ml (equivalent to 0.4% w/v solution)
- Excipients: Hydrochloric acid (used to adjust the pH to a physiologically compatible level) and purified water (solvent)
The absence of preservatives is a significant advantage for ophthalmic medications. Preservatives such as benzalkonium chloride, commonly used in multi-dose eye drop formulations, are known to cause dose-dependent cytotoxicity to corneal epithelial cells. By using a preservative-free, single-dose container format, Bausch + Lomb minimizes the risk of chemical irritation and preservative-related allergic reactions.
Packaging and Appearance
The product is supplied as single-dose containers made of flexible plastic, each containing 0.5 ml of clear, colorless solution. Each box contains 20 single-dose containers, individually wrapped in protective outer pouches. To use, the single-dose container is removed from its outer pouch and the closure is twisted off. The drops should be instilled into the eye immediately after opening.
Marketing Authorization Holder and Manufacturer
The marketing authorization is held by Bausch + Lomb Ireland Limited, 3013 Lake Drive, Citywest Business Campus, Dublin 24, D24 PPT3, Ireland. The product is manufactured by Laboratoire Chauvin S.A., Z.I. Ripotier, 07200 Aubenas, France.
Frequently Asked Questions
References
- Bausch + Lomb Ireland Limited. Oxibuprocaine Bausch & Lomb — Summary of Product Characteristics. Last updated 2022.
- European Medicines Agency (EMA). Guideline on the investigation of bioequivalence — Annex on ophthalmic products. EMA/CHMP/QWP/558185/2013.
- British National Formulary (BNF). Local anaesthetics — Ophthalmic. National Institute for Health and Care Excellence. Accessed January 2026.
- Lawrenson JG, Edgar DF, Tanna GK, Gudgeon AC. Comparison of the tolerability and efficacy of unit-dose, preservative-free topical ocular anaesthetics. Ophthalmic and Physiological Optics. 1998;18(5):393-397.
- World Health Organization (WHO). WHO Model List of Essential Medicines — 23rd edition, 2023. Geneva: World Health Organization.
- McGee HT, Fraunfelder FW. Toxicities of topical ophthalmic anesthetics. Expert Opinion on Drug Safety. 2007;6(6):637-640.
- Moreira LB, Kasetsuwan N, Sanchez D, et al. Toxicity of topical anesthetic agents to human keratocytes in vivo. Journal of Cataract and Refractive Surgery. 1999;25(7):975-980.
- Rosenwasser GO. Complications of topical ocular anesthetics. International Ophthalmology Clinics. 1989;29(3):153-158.
- U.S. Food and Drug Administration (FDA). Ophthalmic drug products for over-the-counter human use — local anesthetic and vasoconstrictor products. 21 CFR Part 349.
- Bartfield JM, Holmes TJ, Raccio-Robak N. A comparison of proparacaine and tetracaine eye anesthetics. Academic Emergency Medicine. 1994;1(4):364-367.
About the Medical Editorial Team
This article was written and medically reviewed by the iMedic Medical Editorial Team, which includes licensed physicians specializing in ophthalmology, clinical pharmacology, and evidence-based medicine. Our team follows international guidelines from the WHO, EMA, BNF, and FDA to ensure all content meets the highest standards of medical accuracy.
All medication articles undergo a rigorous three-stage review: (1) initial clinical content creation by a specialist physician, (2) pharmacological accuracy review against approved prescribing information, and (3) final editorial review for clarity and accessibility.
We use only peer-reviewed sources, approved product information (SmPC/prescribing information), and established pharmacological references (BNF, Martindale). Evidence level 1A is maintained across all clinical claims.