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Cycloplegics are very safe and useful medications. To avoid the unpleasant side effects of these medications, six precautions are considered. They are: 1. dosage, 2. cycloplegic selection, 3. toxic reaction, 4. biologic variations, 5. topical anesthesia, 6. environmental temperature and humidity.
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Data on DPA side effects were gathered from six schools and colleges of optometry for a reporting period from February 1 to April 30, 1979. These data indicate a low incidence of mild and transient side effects caused by several of the DPAs.
Complications from mydriatic and cycloplegic drugs are rare compared with their extensive use. Adverse effects are often related to dosage or other factors. The ocular complications include increased intraocular pressure, pigmentation of the conjunctiva and cornea, pigment in the anterior chamber, lacrimal duct blockage, macular edema, corneal endothelium damage, hyperemia, allergy, discomfort, and blurred vision. The systemic complications are those common to sympathomimetic and parasympatholytic drugs and include tachycardia, hypertension, headache, faintness. pallor, trembling, excessive sweating, palpitations, arrhythmias, confusion, hallucinations, drowsiness, ataxia, flushed skin, high fever, dysarthria, thirst, dry mouth, convulsions, disorientation, nervousness, coma, and death. An understanding of all possible side effects is of paramount importance to those using these drugs in the treatment of anticholinesterase poisoning. This review is intended as a ready reference to the adverse effects of mydriatic and cycloplegic drugs.
We describe the use of long-term dilation and patching therapy in the management of three cases of pediatric monocular cataract. The cataracts were felt to be visually significant in the undilated state but consistent with good formed vision in the dilated state. One patient had a congenital cataract managed from 4 weeks of life, and two patients had late diagnosed cataracts of indeterminate onset presenting with dense deprivation amblyopia. The congenital cataract patient ultimately demonstrated recognition acuity of 20/40, and both the older children ultimately demonstrated an acuity of 20/30. We recommend considering long-term dilation and conventional amblyopia therapy rather than lensectomy in such cases if the cataract is felt to be consistent with development of good formed vision in the dilated state.
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BACKGROUND: The topical administration of eyedrops is often an unpleasant procedure in the pediatric population. We sought to learn whether a combination mydriatic-cycloplegic solution would be an effective cycloplegic if delivered as a spray. METHODS: We conducted a prospective, examiner-masked, parallel-group study and randomized 38 subjects (age range 6 months to 12 years, mean = 7.3 years) into four groups such that the same combination mydriatic-cycloplegic solution was administered under the following conditions: 1) eyedrops to eyes that were open; 2) eyedrops to eyes that were closed; 3) spray to eyes that were open; 4) spray to eyes that were closed. Both eyes of each subject received the solutions administered under one of the four conditions. Residual accommodation was measured using dynamic retinoscopy and the subjective push-up method, where applicable, at times 0, 10, 20, 30, 45, and 60 mins following administration of the medications. RESULTS: Repeated measures analysis of covariance revealed no statistically significant difference (p > 0.05) in cycloplegic efficacy among the four methods of drug delivery. CONCLUSIONS: The results of this study suggest that administering cycloplegics by spray to the closed eye is as efficacious as instilling eyedrops to the open eye. Use of a cycloplegic spray can have important clinical advantages compared to conventional cycloplegic eyedrops administered to children.
BACKGROUND: The topical administration of eyedrops is often an unpleasant procedure in the pediatric population. We sought to learn whether a combination mydriatic-cycloplegic solution would be an effective mydriatic if applied as a spray. METHODS: We used a prospective, examiner-masked, parallel-group study design and randomized 38 subjects (age range 6 months-12 years, mean = 7.3 years) into four groups such that the same combination mydriatic-cycloplegic solution was administered under the following conditions: 1) eyedrops to eyes that were closed; 2) eyedrops to eyes that were open; 3) spray to eyes that were closed; 4) spray to eyes that were open. Both eyes of each subject received the solutions administered under one of the four conditions. Photographs were taken of each subject's pupils at times 0, 5, 15, 25, 40, and 55 mins following administration of the medications. RESULTS: Repeated measures analysis of variance revealed no statistically significant difference (p > 0.05) in mydriatic efficacy among the four methods of drug administration. CONCLUSIONS: The results of this study suggest that the mydriatic efficacy of a mydriatic-cycloplegic spray is comparable to that associated with eyedrop instillation. Mydriatic sprays may have important clinical advantages over conventional ophthalmic solutions in the pediatric population.
Two cases are presented in which unilateral transient angle-closure glaucoma accompanied occlusion of the central retinal vein. In both cases, the uninvolved eye had a wide-open angle and the involved eye demonstrated a marked anterior displacement of the lens-iris diaphragm. Short-term treatment with cycloplegics and carbonic anhydrase inhibitors resulted in a rapid and permanent deepening of both angles. The similarity of this picture to malignant glaucoma as well as possible causative factors is discussed.
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BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the results of myopic excimer laser photorefractive keratectomy (PRK) performed using three different ablation approaches. PATIENTS AND METHODS: Using the Apex excimer laser (Summit Technology, Inc., Waltham MA), we have treated 75 eyes. Twenty-five of them were treated by a single ablation zone (SA, 6.5 mm diameter) to correct myopia of -4.50 +/- 2.10 D (mean +/- SD); 25 eyes underwent PRK for the correction of myopia of -4.98 +/- 2.17 D using a multipass multizone technique (MP, 3 zones); and 25 eyes were corrected for myopia of -5.03 +/- 1.98 D using new software which enables the creation of three ablation zones in a single-pass fashion (MZ). RESULTS: Mean refractive error (+/-SD) at the first post-operative month was +1.34 +/- 1.00 D for SA, +1.78 +/- 1.49 D for MP, and +0.90 +/- 0.75 D for MZ. Eyes treated by MZ had significantly better uncorrected visual acuity than those treated by SA (P=0.04). Corneal topography revealed a central island in 14 eyes (56%) of those treated by SA and 2 eyes (8%) of those treated by MZ, but in no eyes treated by MP. Six months after treatment, mean refractive error was +0.28 +/- 0.75 D for SA, +0.36 +/- 0.92 D for MP, and - 0.07 +/- 0.77 D for MZ. CONCLUSION: MZ ablation induced less hyperopic shift at 1 month, thus leading to a faster visual recovery and better uncorrected visual acuity. MP and MZ ablations proved effective in preventing central island formation, thus inducing less visual disturbances than SA ablations. These results suggest that MZ ablation may be preferable to the other techniques in performing myopic PRK.
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BACKGROUND: A study was performed to compare the clinical effectiveness of a nondilated fundus examination to a dilated fundus examination. METHODS: The population consisted of 90 pediatric patients aged 5 to 16 years. Subjects were randomly selected from patients presenting for a routine eye examination at the Eye Institute of the Pennsylvania College of Optometry. Direct ophthalmoscopy was performed on the subjects before pupillary dilation while direct and binocular indirect ophthalmoscopy were performed post-dilation. RESULTS: Twenty-three patients (25.5 percent) had one or more posterior pole anomalies not detected by the nondilated pupil examination. A total of 30 posterior pole anomalies were not detected by the nondilated pupil examination. Forty-six patients (51 percent) had one or more peripheral anomalies not detected by the nondilated pupil examination. Sixty-nine total peripheral anomalies were not detected by the nondilated pupil examination. CONCLUSIONS: A dilated fundus examination provides a more effective clinical method for evaluating intraocular health in a pediatric population.
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PURPOSE: To evaluate the advantage of intracameral unpreserved lidocaine for patient comfort during phacoemulsification under topical anesthesia. METHODS: In this prospective study, we performed 80 phacoemulsifications under topical anesthesia, with tetracaine 1% drops, 10 minutes before and at the start of surgery: 40 patients received 0.3 cc balanced salt solution (BSS) intracameral injection; 40 patients received 0.3 cc unpreserved lidocaine 1% intracameral injection. The same surgical procedure was performed in both groups: 3.2 mm temporal corneal self-sealing incision, capsulorhexis, foldable polyHEMA IOL implantation into the capsular bag. There was no intravenous sedation. RESULTS: Forty-eight percent (19) in the BSS group and 70% (28) in the lidocaine group felt no pain. 10% (4) in the BSS group reported sharp pain during phacoemulsification. During IOL insertion, no pain was reported by 48% (19) in the BSS group, and 75% (30) in the lidocaine group; 10% (4) in the BSS group felt severe pain (significant difference: p < 0.05). Endothelial cell loss was 6% in the BSS group, and 6.4% in the lidocaine group (non significant difference). CONCLUSION: Intracameral lidocaine is safe and effective in decreasing discomfort among patients undergoing phacoemulsification under topical anesthesia.