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PubMed2005

Changes in chromatic and achromatic contrast sensitivities following tropicamide administration.

PURPOSE: To investigate the effects of tropicamide on chromatic and achromatic contrast sensitivities over the physiological range of spatial frequencies. METHODS: A total of 26 healthy volunteers, with a mean age of 32 years, were examined with and without one drop of 1% tropicamide being administered 30 min previously. On each occasion, acuity and pupil diameter were recorded, and chromatic and achromatic contrast sensitivities were examined using the Sussex Grating Machine. RESULTS: Following tropicamide administration mean pupil diameter increased from 4.1 mm to 7.2 mm (P<0.001), and mean BCVA was reduced by 0.07 LogMar units (P<0.001). Achromatic contrast sensitivity was significantly reduced following tropicamide administration at 2.20 cycles per degree (cpd) (P=0.01), 3.40 cpd (P=0.01), 10 cpd (P=0.04), 17 cpd (P=0.04), and 25 cpd (P<0.01). There was no difference in contrast sensitivity at lower spatial frequencies (0.33 and 0.66 cpd). Chromatic contrast sensitivity was not significantly altered when tested along the red-green and tritan confusion axes. CONCLUSIONS: Achromatic contrast sensitivity is significantly reduced following tropicamide administration at intermediate and high spatial frequencies. No significant changes were seen at low spatial frequencies and in chromatic contrast sensitivities.

Administration, Topical↗
PubMed2002

Effects of topical 0.5% tropicamide on intraocular pressure in normal cats.

The objective of the study was to determine the effect of topical 0.5% tropicamide on intraocular pressure (IOP) in normotensive feline eyes. IOP was measured bilaterally in 70 clinically healthy cats and gonioscopy (and goniophotography) was performed. Thereafter, 50 cats were treated unilaterally with one drop of 0.5% tropicamide. The contralateral, left eye served as a control. In the placebo group consisting of 20 cats, one drop of physiologic saline solution was administered to the right eye. In all cats, IOP of both eyes was measured 30, 60 and 90 min after topical administration. After unilateral tropicamide application, IOP increased significantly both in the right and in the left eye. Maximum average IOP increase was observed at the control measurement performed 90 min after treatment, with an elevation of 3.8 +/- 4.2 mmHg in the right eye and 3.5 +/- 3.6 mmHg in the left eye. Maximum IOP increase after treatment was 18.0 mmHg in the treated eye and 17.0 mmHg in the left eye. Measurements made at 60 min after treatment revealed a significantly higher increase in IOP in the right eye as compared to the left eye (P60 < 0.05), whereas the differences between right and left eye in IOP increase were not significant at 30 and 90 min after mydriatic application (P30 = 0.123; P90 = 0.305). Although tropicamide-induced mydriasis was observed in the treated eye, the contralateral eye did not show any changes in pupillary function at any time. With increasing age of the cats, IOP increase was found to be more moderate, whereas the gender of the cats did not have any significant influence on IOP changes. In the 20 cats in the placebo group, no significant changes in IOP were observed. We conclude that topical 0.5% tropicamide causes a significant elevation of IOP in the treated and untreated eye in normal cats.

Administration, Topical↗
PubMed1982

Mydriatic effectiveness of dilute combinations of phenylephrine and tropicamide.

The effects of two solutions, each consisting of a combination of tropicamide and phenylephrine at lower than conventional concentrations, were studied in 79 students at Pacific University College of Optometry. Clinically effective diameters (CED's), measured when the eye was illuminated for direct ophthalmoscopy, were followed for 90 min after mydriatic instillation. Intraocular pressure (IOP), systolic arterial blood pressure (sBP), and the systolic BP/IOP ratio were also monitored for 90 min. Both combination A (0.25% tropicamide + 1.25% phenylephrine) and combination B (0.125% tropicamide + 2.0% phenylephrine) produced CED's as large as produced by 0.5% tropicamide in the opposite eye. By combining a low concentration of a sympathomimetic with a parasympatholytic agent, it is possible to achieve mydriasis superior to that produced by 0.5% tropicamide or 2.5% phenylephrine while reducing the risk of systemic or ocular side effects.

Adult↗
PubMed1993

Comparison of cyclopentolate versus tropicamide cycloplegia in children.

This double masked study compares the cycloplegic effects of tropicamide 1% and cyclopentolate 1% in 20 nonstrabismic, nonamblyopic, hyperopic 6- to 12-year-old children with a mean refractive error = +1.48 +/- 1.10 diopters (D). Unlike previous studies which used only amplitude of accommodation to measure the depth of cycloplegia, this study compares refractive error as determined by retinoscopy, distance subjective refraction, and distance autorefraction (Canon R-1). In addition, we compare the amplitude of accommodation as measured by subjective push-up and objective autorefraction methods. There is no statistically significant difference between cyclopentolate and tropicamide for either cycloplegic retinoscopy or distance subjective refraction. Autorefraction measurement of refractive error shows a statistically significant but clinically unimportant bias (0.14 +/- 0.30 D) toward more hyperopia with cyclopentolate. Both drops reveal latent hyperopia, and the mean latencies are not statistically different between the two cycloplegic agents. Latent hyperopia is not systematically related to the degree of hyperopia after tropicamide, but this relation is significant after cyclopentolate. No differences were found between refractive results with either agent at 30 min compared to 60 min after drop instillation. When measured objectively with the autorefractor, accommodation is inhibited more effectively by cyclopentolate than by tropicamide. Our results suggest that although tropicamide is not as effective as cyclopentolate in inhibiting accommodation it is, nevertheless, a useful cycloplegic agent for measuring distance refractive error of low to moderate hyperopia in school-aged children.

Accommodation, Ocular↗
PubMed1997

Effect of proparacaine on tropicamide-induced mydriasis.

PURPOSE: The use of a topical anesthetic before the instillation of a mydriatic is recommended in order to enhance both the rate and magnitude of pupillary dilation. However, there is a paucity of data supporting the prior use of topical anesthetics with tropicamide, the most commonly used mydriatic agent in optometric practice. Therefore, we conducted a study to determine the clinical effect of proparacaine on tropicamide-induced pupillary dilation. METHODS: We investigated the effects of prior instillation of 0.5% proparacaine (Ophthetic) on pupillary dilation with 0.5% tropicamide (Mydriacyl) using a double-blind, placebo-controlled protocol on two groups of young adult subjects. Thirty subjects, aged between 18 and 30 years, were divided into 2 groups of 15, based on whether they had light- or dark-colored irides. The pupils of both eyes of each subject were dilated with tropicamide, but only one eye, chosen at random, received proparacaine (experimental condition), whereas the other was administered a saline placebo (control condition). Pupil diameter was measured using a ruler and magnifying loupe. RESULTS: Subjects with light-colored irides had a greater average pupil dilation than subjects with dark-colored irides. There was a small, statistically significant difference in pupil diameter between the control and experimental conditions, but only for subjects with light-colored irides. The rate of pupillary dilation to peak pupil diameter and the rate of decrease in pupil diameter after peak pupil diameter was reached did not differ between experimental conditions or subject groups. CONCLUSIONS: Although prior instillation of topical proparacaine produced a statistically significant difference in pupil diameter for subjects with light-colored irides, the result was not clinically significant. Therefore, we do not recommend the use of a topical anesthetic before tropicamide-induced mydriasis for young adult patients.

Administration, Topical↗
PubMed2005

The mydriatic effect of multiple doses of tropicamide.

PURPOSE: We investigated whether two drops of 0.5% tropicamide produced a wider pupillary dilation when compared with a single drop and saline control in subjects with dark-colored irides. METHODS: Twelve young adult subjects with dark irides and who were free from ocular disease participated in the study. One eye of each subject, selected at random, was designated as experimental and the fellow eye as control. A single drop of 0.5% tropicamide was instilled in the lower cul-de-sac of each eye in turn. Immediately after, a second drop of 0.5% tropicamide was instilled in the experimental eye and a single drop of unpreserved saline into the control eye. A double-masked experimental protocol was followed. Digital images of both pupils of each subject were taken at baseline (predrug instillation) and then every 5 minutes up to 30 minutes postdrug instillation and at 40, 50, and 60 minutes. The images were subsequently viewed on a PC monitor, and pupil size was measured using a calibrated millimeter scale. RESULTS: Pupil diameter increased as a function of time for both conditions reaching a maximum between 20 and 30 minutes after drop instillation. Pupil diameter was greater under the experimental condition compared with the control (analysis of variance p < 0.001). Pupil diameter reached at least 6 mm under both the experimental and control conditions. CONCLUSION: In young healthy subjects, compared with a single drop of tropicamide, two drops were associated with a greater degree of pupillary dilation on average over the 60-minute study period. However, the magnitude of the difference was small and not clinically significant. A single drop of tropicamide produced a pupillary diameter of at least 6 mm, which should be sufficient for the conduct of a thorough dilated fundus examination.

Adult↗
PubMed2003

Insulin and tropicamide accumulate in the contralateral, untreated eye of rats following ipsilateral topical administration by a mechanism that does not involve systemic uptake.

BACKGROUND: This study was designed to determine: (1) whether the accumulation of insulin in the contralateral retina and aqueous humor following ipsilateral topical insulin administration was due to systemic uptake and (2) whether tropicamide, applied to one eye, could induce dilation in the contralateral eye by a mechanism that did not involve systemic uptake. METHODS: Insulin eye drops were applied to the left eye of intact and decapitated rats, and their retinas and aqueous humors were then removed and their insulin levels quantified. In a separate experiment live animals received 0.1% tropicamide in their left eye and had their pupillary dilation response in both eyes measured at different time points. RESULTS: Administration of insulin to the left eye of decapitated rats resulted in its significant accumulation not only in the left retina and aqueous humor, but also in the retina and aqueous humor of the right eye. Similar aqueous humor results were obtained when live animals were used. Tropicamide drops induced marked pupillary dilation in treated eyes; the pupils of the contralateral, untreated eyes also dilated significantly, but less than did the treated pupils. The pupils of rats injected with tropicamide intravenously showed negligible dilation. CONCLUSIONS: These results showed that insulin accumulated in the retina and aqueous humor of contralateral, untreated eyes following topical application, by a mechanism that did not appear to involve systemic uptake. Similarly, tropicamide provoked a dilation response in the unheated eye by a mechanism that similarly did not appear to involve uptake from the blood.

Absorption↗
PubMed1996

The effects of tropicamide on mydriasis in young rats exhibiting a natural deficit in passive-avoidance responding.

The young rat at post-natal day 18-22 exhibits a natural deficit in passive-avoidance responding that can be corrected with the acute systemic administration of different cholinomimetic drugs, such as tacrine. In order to evaluate the generality of this apparent cholinergic hypofunction, different doses of the anticholinergic agent tropicamide, were administered either systemically or dropped directly into the eye of young or adult rats. Tropicamide produced mydriasis in a dose-dependent manner. The ED50 for tropicamide dropped into the eye was 0.025% for adult rats and 0.12% for young rats. When doses between 0.3 and 100 mg/kg were delivered systemically, the mean time course for recovery to baseline pupil size was accelerated in young rats. The average time to recovery across all doses was 112 +/- 27 min (mean+/-SE) for young rats and 274 +/- 70 min for adults. When subcutaneous tacrine was given immediately to young rats after training in a passive-avoidance response (PAR) task, retention was enhanced at testing 24 hours later in a dose-dependent manner. The response latencies were statistically different from saline-treated controls at doses of 0.003 and 0.01 mg/kg. This was not observed in adult rats. Taken together these results suggest that the PAR, along with the mydriacyl response of the young rat to tropicamide, may be regulated by a system of subsensitive cholinergic receptors.

Aging↗
PubMed2005

Pupil response to tropicamide following laser in situ keratomileusis.

PURPOSE: To investigate the effect of corneal thinning after laser in situ keratomileusis (LASIK) on the corneal penetration of topical eye medication. SETTING: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. METHODS: Laser in situ keratomileusis surgery was performed in 19 eyes of 10 patients enrolled in this prospective study. Measurements were made before surgery and 3 months postoperatively. After instillation of tropicamide 1%, the change in pupil size over time was measured with a Colvard pupillometer. Central corneal thickness (CCT) was measured with ultrasonic pachymetry before and 3 months after LASIK. The corneal epithelial condition was also examined by fluorescein dye staining. RESULTS: The mean CCT decreased significantly from 564 microm +/- 33 (SD) before LASIK surgery to 514 +/- 48 microm 3 months postoperatively (P<.0001). Pupil diameter 10, 15, and 20 minutes after tropicamide 1% instillation was significantly larger 3 months after surgery than preoperatively (P=.0083, P=.0043, and P=.0144, respectively). The mean time to reach a pupil diameter of 6.0 mm decreased significantly from 14.4 +/- 4.3 minutes in preoperative eyes to 11.5 +/- 2.3 minutes in postoperative eyes (P=.0281). Mild punctate corneal epithelial staining (fewer than 5 spots) were observed in 4 eyes at the 3-month postoperative examination. CONCLUSIONS: Pupil dilation after tropicamide 1% instillation was significantly faster after LASIK surgery. Corneal thinning that resulted from LASIK enhanced corneal penetration of tropicamide 1%.

Adult↗
PubMed2003

Re-evaluation of tropicamide in the pupillary response test for Alzheimer's disease.

In 1994, a pupillary response test using very dilute (0.01%) tropicamide, a cholinergic antagonist, evoked remarkable pupil dilation in subjects with Alzheimer's disease (AD) and has since been considered a diagnostic tool for AD. However, since this test was first reported, there have been studies suggesting it cannot provide a differential diagnosis of AD. Thus, the present study re-evaluated the pupillary dilation of AD (n=17) and non-AD (n=20) subjects at a 0.01% concentration of tropicamide and found that non-AD subjects, including young subjects, showed the same extent of pupil dilation as AD subjects. Furthermore, there was no significant difference between the average dilation rate of the two groups (P>0.05). When the tropicamide concentration was diluted to half of the initial concentration and performed for AD (n=14), vascular dementia (VD) (n=14), and young (n=16) subjects, the AD subjects showed a large dilation (mean pupil dilation rate: 133.8+/-15%) while the non-AD subjects did not show hypersensitivity to the new concentration of eye drops (105.4+/-9%). These differences in pupillary dilation between AD and non-AD patients were statistically significant (P<0.001). Based on these results, the most effective cutoff point of 0.005% tropicamide for differential diagnosis was 114.5% of the average pupil dilation rate for 60 min.

Adult↗
PubMed2003

Randomized clinical trial of the efficacy and safety of tropicamide and phenylephrine in preoperative mydriasis for phacoemulsification.

PURPOSE: To compare the mydriatic effect and safety between different concentrations of tropicamide and phenyle-phrine in preoperative mydriasis for phaco-emulsification. METHODS: Two hundred and seventeen consecutive eyes in the same number of Chinese patients undergoing phaco-emulsification under local or topical anaesthesia in a university-based eye hospital were analyzed. Patients were randomized into two groups by cluster randomization, each group receiving a different preoperative mydriatic regimen. Regimen A consisted of tropicamide 1.0% with phenylephrine 2.5%, and Regimen B consisted of tropicamide 0.5% with phenylephrine 0.5%. The main outcome measures were horizontal pupillary diameter, systolic, diastolic and pulse pressure and pulse rate. RESULTS: The group who received Regimen A attained a mean horizontal pupillary diameter of 7.00 +/- 1.06 mm. Their pupils were significantly larger than those receiving Regimen B (6.61 +/- 1.03 mm, P = 0.007). No untoward cardiovascular effects were noted in either groups. CONCLUSION: Regimen A attained better preoperative mydriasis for phacoemulsification than Regimen B. Both regimens were safe with regard to their cardiovascular effects. The combination of tropicamide 1.0% and phenylephrine 2.5% is recommended as preoperative mydriatic for phacoemulsification in Chinese patients who have darkly pigmented irides.

Aged↗
PubMed2001

The effects of topical tropicamide and systemic medetomidine, followed by atipamezole reversal, on pupil size and intraocular pressure in normal dogs.

Twenty normal Golden Retrievers being screeened for eye, hip and elbow diseases were given tropicamide topically and medetomidine systemically. Medetomidine effects were later reversed with systemic atipamezole. Pupil size and intraocular pressure changes were determined. Pupil size increased significantly following tropicamide administration and continued to increase slightly but significantly after medetomidine injection. It was unclear whether the slight increase in pupil size following medetomidine administration was due to continued effect of tropicamide or due to the medetomidine itself. Atipamezole did not influence pupil size. Intraocular pressure (IOP) was not affected by these drugs. Ophthalmic screening examination for inherited disease following tropicamide administration is equally feasible prior to sedation with medetomidine and after reversal with atipamezole, but not during the period of sedation.

Administration, Oral↗
PubMed2000

Enhancement of the mydriatic response to tropicamide by bioadhesive polymers.

The aim of this work was to evaluate how the addition of mucoadhesive polymers to aqueous solutions affects the ocular response of tropicamide (0.2%; w/v). The polymer solutions tested were carboxymethylcellulose sodium salt (CMC-Na; 1%; w/v), hyaluronic acid sodium salt (HA-Na; 0.1%; w/v) and polyacrylic acid (PAA; 0.2%; w/v). Polymeric solutions were compared to a nonviscous formulation (AS). In vitro mucoadhesion measurements were expressed as a percentage of the adhesion force mucin-mucin, considering this one as 100% mucoadhesion. The values ofmucoadhesion obtained were 172%, 127%, 103% and 87.6% for formulations with CMC, PAA, HA and AS, respectively. The mydriatic response of tropicamide was determined in adult male New Zealand rabbits, weighing 1.7-2 Kg, by pupil diameter measurements at different times after instillation. The area under the mydriatic response-time curve (AUC 0-6 hr) was interpreted as an indication of the bioavailability of tropicamide in each vehicle. The AUC 0-6 hr was related to the in vitro mucoadhesion for each formulation. Tropicamide solutions with CMC-Na and PAA resulted in mucoadhesion and AUC 0-6 hr values approximately 1.9 and 1.4 times higher than AS. Although the solution with HA-Na was less mucoadhesive than PAA, the hyaluronic acid solution resulted in a higher AUC mydriasis/time value. Formulations with HA-Na and PAA presented values of surface tension close to that observed in the lacrimal fluid, with the Imax (maximum pupil diameter) being higher than for CMC-Na and AS. Greater than 90% of the mydriatic effect disappeared 4.5 hr after instillation for PAA and AS. Nevertheless, the mydriatic effect remained up to 5.5 hr for HA-Na and CMC-Na. HA-Na solution enhanced the bioavailability oftropicamide, presenting a value of mucoadhesion similar to the reference mucin-mucin.

Acrylic Resins↗
PubMed2001

Retinoscopy in infants using a near noncycloplegic technique, cycloplegia with tropicamide 1%, and cycloplegia with cyclopentolate 1%.

PURPOSE: This study compares retinoscopy in infants using a near noncycloplegic technique, cycloplegia with tropicamide 1%, and cycloplegia with cyclopentolate 1%. The study sample included 29 healthy, nonstrabismic infants 4 to 7 months of age (mean 5.71 months). METHODS: Each study subject was examined at two separate visits an average of 2 weeks apart (mean [+/-SD] 14 +/- 9 days). The examiner completed a case history, iris color grading, confrontation tests, and noncycloplegic near retinoscopy in a dark room and then instilled a drop of topical anesthetic in each eye followed by 2 drops of cycloplegic agent separated by 5 min. Retinoscopy was performed 25 to 30 min after the first drops were instilled. The bottles were masked, and the drop administered at the first visit was randomly assigned. RESULTS: On a scale of 0 to 4.9, the median iris grade was 4.0, which corresponds to a brown or darkly pigmented iris. All reported retinoscopy results are for the horizontal meridian of the right eye. The mean refractive error using noncycloplegic near retinoscopy was +0.94 D (+/-1.19 D). The mean refractive error was +1.81 D (+/-1.19 D) with tropicamide and +1.88 D (+/-1.45 D) with cyclopentolate. There was no statistically or clinically significant difference between the two cycloplegic measurements using different diagnostic agents (t = -0.46, p = 0.65). The mean difference between noncycloplegic and cycloplegic retinoscopy was 0.89 D (+/-0.66 D) with tropicamide (t = -6.57, p < 0.0001) and 1.04 D (+/-0.94 D) with cyclopentolate (t = -5.38, p < 0.0001; all two-sided paired t-tests). There were no serious adverse reactions with either agent, although one infant temporarily developed redder than normal cheeks after instillation of cyclopentolate. CONCLUSION: Our results suggest that tropicamide is as effective as cyclopentolate for the measurement of refractive error in most healthy, nonstrabismic infants.

Ciliary Body↗
PubMed2004

A double-blind study comparing 0.5% and 1% tropicamide for annual retinal screening in diabetic adolescents.

AIMS: To determine whether there is any difference between 0.5% and 1% tropicamide in ocular discomfort and mydriatic efficacy in adolescents with Type 1 diabetes. METHODS: In a double-blind study, one drop of 0.5% tropicamide was instilled in one eye and one drop of 1% instilled in the other eye of 30 subjects aged 12-18 years. Drop strengths were randomized. Pupil size was measured before instillation, at 10, 20 and 30 min. Discomfort was measured using a recognized pain scale. RESULTS: Irrespective of the concentration of tropicamide used, all pupils dilated to at least 6 mm at 30 min, sufficient for successful ophthalmoscopy. Pain was significantly less when the lower concentration of tropicamide was used; pain score for the 0.5% group [median (interquartile range)] 1.0 (0-2) and 2.0 (1-3) for the 1.0% group, P = 0.009 (Wilcoxon rank test). CONCLUSIONS: This minor change in practice significantly reduces the distress associated with drop instillation without compromising the clinical examination, and may thus be important in encouraging compliance at the yearly diabetic review.

Adolescent↗
PubMed1999

Receptor test (pupillary dilatation after application of 0.01% tropicamide solution) and determination of central nervous activation (Fourier analysis of pupillary oscillations) in patients with Alzheimer's disease.

Memory loss and severe cognitive deficits in Alzheimer patients are supposed to be related to a reduction of acetylcholine as well as to central nervous deactivation. For the investigation of cholinergic deficits and deactivation, we used computer-assisted pupillometry. Cholinergic deficits caused by a particularly severe loss of cholinergic neurons may be responsible for cognitive and mnemonic performance deficits. The control of the pupillary diameter represents a balance between cholinergic and adrenergic innervation and is influenced directly or indirectly by central and autonomic nervous system inputs. Either of these systems could be affected in Alzheimer patients. A reduced innervation of the target muscle through neuronal cell death, axon retraction, reduced release, increased reuptake of altered amounts or function of neurotransmitter receptors seems to affect the pupillary response to cholinergic antagonists in Alzheimer patients. There is, however, no relationship between pupillary diameter and central deactivation, but between central nervous activation and pupillary oscillations which reflect the physiological corticodiencephalic activity, a relationship has to be assumed. Frequencies and amplitudes of pupillary oscillations measured by means of Fourier analysis are modulated corticodiencephalically. Therefore, Alzheimer patients were compared to healthy controls with respect to their pupillary diameters and responses to an acetylcholine antagonist. Twenty-nine patients, aged between 55 and 85 years, suffering from mild to moderate Alzheimer's disease (AD) and 29 normal controls of similar age (56-85 years) participated in the study. The cholinergic receptors of the pupil were blocked by the acetylcholine antagonist tropicamide. It could be assumed that the larger the pupillary dilatation, the larger the extent of cognitive deficits. Alzheimer patients show abnormal acetylcholine neurotransmission. Changes of pupillary diameter after instillation of 1 drop of 0.01% tropicamide solution were measured and Fourier analysis of pupillary oscillations was performed. Times of measurement were: 0 (baseline), 20, 40, 60, 80, and 100 min. After 4 min tropicamide was instilled. Forty min after the instillation of tropicamide into the left eye, the Alzheimer patients showed a pronounced dilatation of 41.57%. The dilatation in normal controls was 28.5%. Fourier analysis of pupillary oscillations (sum of frequency bands = power) demonstrated a marked deactivation (low amplitudes in low-frequency bands, but in contrast to our expectations no higher amplitudes in the higher frequency bands) in patients with AD which remained constant at all times of measurement. By means of discriminant analysis of pupillary diameter and pupillary oscillations (frequency band 0.00-1 Hz), 89. 7% were correctly predicted to be Alzheimer patients, 89% to be normal controls.

Aged↗
PubMed1997

Tropicamide eyedrops cannot be used for reliable diagnosis of Alzheimer's disease.

OBJECTIVE: To evaluate the mydriatic effect of tropicamide eyedrops as a diagnostic test for Alzheimer's disease. MATERIAL AND METHODS: In a double-blind, placebo-controlled study, we assessed pupillary responses in 22 normal control subjects, 23 patients with probable Alzheimer's disease, 4 patients with isolated memory difficulty, and 6 patients with non-Alzheimer's dementia. Three separate studies were performed, the second and third on a subset of the original group. With use of infrared binocular pupillography, after 5 minutes of dark adaptation, we averaged pupil size during a 1-minute interval for baseline determinations. We then instilled 0.01% tropicamide into one eye. In the first two studies, we averaged pupil size for a 1-minute period at 5-minute intervals for 30 minutes, followed by a pupil light reflex test. In the third study, we measured pupil size every 5 minutes for 45 minutes and omitted the light reflex test. RESULTS: No significant difference was noted in pupil dilatation between normal subjects and patients with Alzheimer's disease and between patients with non-Alzheimer's dementias and the Alzheimer's disease group in all three studies. Furthermore, on reperformance of the test in the same patients, more than 50% changed from a group above or below 13% pupil dilatation (a cutoff reported to distinguish Alzheimer's disease from normal control subjects) to the opposite group. CONCLUSION: Results of this study indicate that pupil measurement after instillation of tropicamide cannot be used as a reliable diagnostic test for Alzheimer's disease. Moreover, test-retest reliability with use of dilute tropicamide eyedrops is questionable.

Aged↗
PubMed2001

Evaluation of potentiating effect of a drop of lignocaine on tropicamide-induced mydriasis.

PURPOSE: To analyze whether preinstillation of lignocaine potentiates mydriasis by tropicamide in dark eyes and to determine possible mechanisms for this effect. METHODS: This investigation was conducted in two phases, the first being a double-masked, placebo-controlled, randomized clinical trial, enrolling 60 healthy dark brown eyes in 30 subjects aged 7 to 58 years. The control eye received a drop of (nonlignocaine) placebo before tropicamide 1%, and the contralateral study eye received a 4% lignocaine drop 3-minutes before the 1 drop of tropicamide was administered. A ruled pupillometer recorded pupil diameters every 10 minutes for 50 minutes. In phase II, to elucidate pathomechanisms after lignocaine, corneal and tear parameters were compared with baseline records in a further 60 such eyes. RESULTS: Pupillary diameters in the study eyes increased by 3.62 +/- 0.75 mm, significantly more than in the placebo (control) group (P = 0.000). Ninety percent of study eyes attained the clinically significant 6-mm size with preinstillation of lignocaine-many more than the 67% of control eyes (P = 0.016). The median time to achieve this critical 6-mm size was significantly faster in the study group (P = 0.005). In phase II, the 1 drop 4% lignocaine did not show corneal changes with slit lamp or fluorescein staining and did not reduce media clarity or induce a significant change in tear pH. It markedly decreased Schirmer values (P = 0.000), reduced tear break-up time (P = 0.003), and increased corneal thickness measured by optical pachymetry (P = 0.010). CONCLUSIONS: The phase II findings indicate corneal microepithelial damage and reduced tearing. Both may enhance intraocular penetration and hence potentiation of tropicamide. This remarkable phenomenon could find use with many other important topical medications.

Adolescent↗