Severe toxic reactions and fatalities following the use of tetracaine have repeatedly been reported in the literature, and analysis of these reactions reveal, that practically all of these reactions have occurred after topical application. Recently we observed two cases of severe toxic reaction following topical application of 2% tetracaine solution in oral and pharyngeal mucosa. In both cases reactions were manifested with severe tonic convulsion and shock immediately after the use of tetracaine, and those cases were treated with oxygen inhalation and barbiturate injection. We also discussed the etiology, prevention and management of those reactions.