Lidocaine
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Lidocaine: Punctate epithelial keratoconjunctivitis
One-Sentence Summary
Lidocaine is a local anaesthetic whose relations recorded in the knowledge graph include dermatitis, neuralgia, postherpetic neuralgia, haemorrhoids and several parasitic skin infestations. The TxGNN model predicts it may be useful for punctate epithelial keratoconjunctivitis, but no clinical trials and no publications directly study this disease, so the prediction rests on the model score alone.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Punctate epithelial keratoconjunctivitis |
| TxGNN Prediction Score | 0.9999 |
| Evidence Level | L5 |
| Australia Market Status | Listed on the PBS Schedule (1 of 1 items) – TGA (ARTG) registration status is not included in this data |
| Number of PBS Items | 1 (valid: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Lidocaine is generally known as a sodium channel blocker that provides local anaesthesia and relieves nerve pain. This is background knowledge, not something taken from the compiled data.
A plausible link to ocular surface discomfort or inflammation exists through blockade of sensory nerves. However, there is no supporting clinical data. Topical anaesthetics are also generally avoided for chronic use on a damaged corneal surface because of epithelial toxicity, and misuse of topical anaesthetics is itself a recognised cause of keratopathy. The high TxGNN score should therefore be treated as a hypothesis only.
Other top-ranked predictions are also eye-related (papillary conjunctivitis, rosacea conjunctivitis, exposure keratitis, atopic conjunctivitis, conjunctival disorder). None has a clinical trial or publication showing that lidocaine treats the disease itself.
Clinical Trial Evidence
Currently no clinical trials are registered that directly study lidocaine in punctate epithelial keratoconjunctivitis.
Literature Evidence
Currently no related literature available for punctate epithelial keratoconjunctivitis.
Australia Market Information
| ARTG Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| ARTG 10209H | LIGNOCAINE INJECTION (BRIDGEWEST) | Injection containing lidocaine hydrochloride monohydrate 50 mg in 5 mL | Not stated in the data compiled |
Safety Considerations
No label warnings or contraindications were available in the data compiled for this report. Please refer to the TGA-approved Product Information (PI) for safety information.
Additional information from the compiled data:
- Relations recorded in the knowledge graph (not label text): The knowledge graph links lidocaine with contraindication-type relations for conditions including hypertension, liver failure and liver disease, cirrhosis, kidney disease, epilepsy, adrenocortical insufficiency, hypothyroidism, open-angle glaucoma, osteoporosis, psychotic and other mental disorders, fungal infections, herpes simplex keratitis and varicella zoster infection. These need to be verified against the PI.
- Drug interactions (100 recorded; examples):
- Major: bupropion.
- Moderate: aprepitant, cimetidine, liposomal morphine, obeticholic acid, polyethylene glycol (3350 with electrolytes), picosulfuric acid, sodium sulfate.
- Minor: dexamethasone, kanamycin, neomycin, omeprazole, streptomycin, troglitazone.
- Literature-based safety signals: Neuropsychiatric and cardiac side effects have been reported with intravenous lidocaine (PMID 19250287). A 2026 case report describes methaemoglobinaemia in a child with nephrotic syndrome using topical lidocaine, benzocaine and co-trimoxazole together (PMID 41995267). Lidocaine plasma protein binding is altered in renal disease (PMID 7037263).
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction has a very high model score but no direct clinical or literature support, so the evidence level is L5. Ocular surface use of lidocaine also raises a plausible epithelial toxicity concern. The only Australian licence listed is an injectable product, which does not match an ocular surface route.
To proceed, the following is needed:
- Mechanism of action data and a clear mechanistic rationale for punctate epithelial keratoconjunctivitis
- Preclinical or clinical studies that directly test lidocaine in this disease, including corneal epithelial safety
- A suitable ophthalmic formulation and route assessment, as the current ARTG entry is an injection
- The approved indication text and the PI warnings and contraindications for the listed product
- Review of the interaction and contraindication signals above against the PI
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.