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At least 487 records · Page 27Linked to original sources
PubMed1995

Dapiprazole's effect upon accommodative recovery: is it due entirely to changes in depth of field?

We conducted a study to evaluate the ability of dapiprazole 0.5% ophthalmic solution to reverse accommodative loss brought about by mydriatic drugs having mild cycloplegic effects. To accomplish this, we analyzed data from several earlier randomized, masked clinical studies. Our composite data include over 90 subjects dilated with tropicamide. Tropicamide was used alone in 1% concentration, as well as in combination with phenylephrine, 2.5% and in the proprietary preparation, Paremyd (Allergan Pharmaceuticals). Accommodative amplitude and pupillary diameter were measured before instilling dilating drops and then again one-half hour later, immediately before instilling either dapiprazole or a placebo. Accommodative amplitude and pupil diameter measurements were then repeated four more times, on both the treatment and control eyes and at 30, 60, 120, and 180 min after instillation of the last drop of dapiprazole or placebo. We found accelerated "accommodative" recovery with dapiprazole for each of the three tropicamide-containing drugs used in our study. This is not surprising because some recovery of accommodative amplitude after dapiprazole's administration is expected. This is because dapiprazole accelerates pupillary recovery and a narrowing of the pupil gives rise to an increase in ocular depth of field. Rate of accommodative recovery with dapiprazole was found not to be significantly different for all three tropicamide-containing preparations tested (p > 0.05). Does dapiprazole produce improvement in amplitude of accommodation beyond that attributable to increased depth of field?(ABSTRACT TRUNCATED AT 250 WORDS)

Accommodation, Ocular↗
PubMed1997

Sterility of ophthalmic drugs dispensed from spray bottles.

BACKGROUND: Spray application of cycloplegics and mydriatics is efficacious and frequently easier to use than a standard dropper bottle in the pediatric population. However, no documentation regarding the sterility of drugs dispensed from spray bottles is available. This study was conducted to determine whether contamination of ophthalmic drugs occurs with spray bottle use. METHODS: Fifteen milliliters of 1% cyclopentolate hydrochloride or 0.5% tetracaine hydrochloride were transferred to each of 15 disinfected spray bottles, stored at room temperature or refrigerated, and sprayed three times weekly for 12 weeks. Cultures were obtained from the spray bottles and drugs before transfer of the drug and from spray bottle contents at 0, 2, 4, and 6 to 12 weeks of storage. RESULTS: No cultures showed significant bacterial growth. The bactericidal action of the preservative and sterility of the drugs were maintained. CONCLUSIONS: Despite the transfer to and use of a spray bottle there appears to be minimal risk of instilling contaminated diagnostic drugs using the spray method when a single drug is stored in a spray bottle.

Anesthetics, Local↗
PubMed1994

Dilating the pupil in the pediatric emergency department.

The indications, technique, and drugs for pupillary dilation in the pediatric emergency department have been discussed. Although mydriatic agents are relatively safe, they are not without risks. Physicians therefore need to familiarize themselves with possible adverse reactions that can result from their use. Even when using an appropriate agent, efforts must be made to limit systemic absorption.

Child↗
PubMed2004

Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity.

OBJECTIVE: To determine whether adverse effects manifested via vital sign changes during the screening examination for retinopathy of prematurity (ROP) are due to the pharmacologic properties of the eye drops or to physical manipulation of the eyes. The authors also investigated the relationship between distress during the screening process and the severity of prematurity of the infant. DESIGN AND METHODS: A prospective observational study was designed that enrolled all infants either weighing < or =1500 g or who were < or =32 weeks gestational age at birth who were admitted to the neonatal intensive care unit (NICU) at Northwest Texas Hospital or Baptist St. Anthony's Hospital from June 2002 to February 2003. Thirty participants were enrolled in this study. Blood pressure, pulse, temperature, respiratory rate, and O2 saturation were recorded at different time intervals during the examination. Infants were excluded from the study if they were on the ventilator, considered acutely ill, born with significant birth defects, or currently taking inotropic drugs, or had received albuterol 2 hours before the examination. RESULTS: Oxygen saturation and pulse rate following physical manipulation of the eyes significantly varied from baseline values and the values obtained during the three instillations of topical mydriatics. No significant changes in blood pressure, temperature, or respiratory rate from their respective baseline values were observed throughout the ROP screening examination. Gestational age of the infant did not correlate with level of distress during the examination. CONCLUSION: Regardless of the severity of prematurity, infants seem to undergo significant distress during the eyelid speculum examination. Thus ophthalmologists should take into consideration the infant's discomfort caused by physical manipulation of the eyes and attempt to perform the examination as swiftly, yet safely, as possible using topical anesthetic.

Administration, Topical↗
PubMed1981

Xylazine-induced mydriasis in rats and its antagonism by alpha-adrenergic blocking agents.

Pupillary response to xylazine (10-300 micrograms/kg, i.v.) norepinephrine (1-30 micrograms/kg. i.v.) and atropine (3-100 micrograms/kg, i.v.) were observed in rats anaesthetized with pentobarbital. Xylazine caused a dose-dependent mydriasis which was antagonized by a selective alpha 2-adrenergic blocking agent, yohimbine (2.5 mg/kg, i.v.). was less effective in antagonizing this effect of xylazine. A selective alpha 1-adrenergic blocking agent, prazosin (2.5 mg/kg, i.v.) was ineffective in reducing the xylazine-induced mydriasis. In contrast, both phentolamine and prazosin blocked the pupillary dilation produced by norepinephrine, while yohimbine was much less effective in antagonizing norepinephrine-induced mydriasis. Atropine also induced a dose-dependent mydriasis which was not affected by yohimbine pretreatment. The present study suggests that the mydriatic effect of xylazine in the rat is mediated by an adrenergic mechanism, possibly by stimulating the alpha 2-adrenergic receptors in the iris and CNS.

Adrenergic alpha-Antagonists↗
PubMed1985

The concurrent application of ophthalmic drops.

The significance of the time interval between topical instillation of two different ocular preparations in 63 normal subjects was investigated. The experimental model selected was pupillary dilatation by mydriatic agents. The results indicated that two drugs applied at the "same time" had an equal effect to drugs applied 10 minutes apart. The implications of the study to clinical practice are discussed.

Drug Administration Schedule↗
PubMed1998

Congenital endophthalmitis following maternal shellfish ingestion.

PURPOSE: To highlight an unusual organism causing a unilateral endophthalmitis by transplacental spread. METHOD: We report a case of Plesiomonas shigelloides endophthalmitis, presenting in a newborn, with co-existing septicaemia and meningitis. There was a significant maternal history of diarrhoea associated with the ingestion of oysters 2 weeks prior to delivery. RESULT: The endophthalmitis was treated with parenteral antibiotics and topical mydriatics with complete resolution, although subsequent assessment of the affected eye suggests a poor visual outcome. CONCLUSION: Endophthalmitis in the newborn is an unusual clinical finding and usually presents with other manifestations of bacteraemia. Plesiomonas shigelloides is fortunately an infrequent cause of neonatal infection, but is associated with a high degree of morbidity and mortality. We postulate that this neonate acquired P. shigelloides via the transplacental route, and suggest that this organism be included in the list of 'other' causes of transplacental infection that has been abbreviated to 'O' in the acronym 'TORCH'.

Animals↗
PubMed2005

Tachycardia and myocardial ischaemia following subconjunctival injection of mydricaine (number 02) for vitrectomy procedure.

Mydricaine is a mydriatic agent used routinely at the Royal Adelaide Hospital in subconjunctival injections that are given prior to all vitreoretinal surgery. The drug is manufactured by the hospital pharmacy and each vial of 0.4 mL mydricaine number 02 consists of a mixture of 1.3 mg atropine sulphate, 0.12 mg adrenaline and 8.4 mg procaine hydrochloride. Mydricaine is routinely used by many vitreoretinal units, even though the drug is not listed in the British National Formulary (BNF) or Monthly Index of Medical Specialities (MIMS). Therefore, published case reports provide the main forum for reporting side-effects. The case presented is of a patient with no previous ischaemic heart disease who developed transient myocardial ischaemia with tachycardia following the administration of subconjunctival mydricaine number 02. To the authors' knowledge this is the first case report documenting myocardial ischaemia in a patient with no previous ischaemic heart disease following mydricaine administration.

Aged↗
PubMed2006

Atrial fibrillation following subconjunctival injection of mydricaine number 02.

Mydricaine is a mydriatic agent used as a subconjunctival injection to maintain perioperative mydriasis. The drug consists of a mixture of 1.3 mg atropine sulphate, 0.12 mg adrenaline and 8.4 mg procaine hydrochloride in a single vial of 0.4 mL. It is common practice to use mydricaine injections during vitreoretinal surgery in the Royal Adelaide Hospital. Even though the drug is used widely in many vitreoretinal centres, mydricaine is not listed in the British National Formulary nor Monthly Index of Medical Specialities. Therefore, case reports provide the main forum for reporting side-effects.

Aged↗
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↗
PubMed1988

The effect of mydriasis on the pupillary centration of the human eye.

The change in pupil centration occurring as the human eye pupil dilates, both naturally in darkness and following the use of a mydriatic drug (cyclopentolate HCl, 1%), has been measured photographically. In both cases, changes in centration of up to 0.4 mm have been found. Using available ocular wavefront aberration data, modulation transfer curves have been derived for two eyes for centration changes of 0.2 mm. The importance of these changes in the formation of the retinal image, and hence on visual performance, is discussed.

Adult↗
PubMed1973

Some initial animal and human pharmacological studies with benapryzine (BRL 1288).

1. The pA2 anti-acetylcholine activity in vitro for benapryzine was 6.55 compared with 9.02 for benzhexol.2. In vivo, the anti-acetylcholine activity of benapryzine relative to benzhexol was 0.038 as assessed by the mydriatic response of mice after subcutaneous administration. The relative activity assessed by the inhibition of pilocarpine-induced salivation was 0.13 after oral administration and 0.056 following subcutaneous administration of the drugs.3. Benapryzine had the same order of activity as benzhexol in inhibiting oxotremorine-induced tremors in mice.4. Benapryzine had anticonvulsant properties but no analgesic activity, whilst in high doses it antagonized the extrapyramidal symptoms induced by perphenazine in rats.5. In patients benapryzine was effective in reducing the symptoms of Parkinson's disease without overt anti-cholinergic effects or central hallucinogenic actions.6. Benapryzine abolished the excess tremor and reduced the rigidity and akinesia induced by physostigmine in Parkinsonian subjects.

Acetylcholine↗
PubMed1983

alpha 2-Adrenoceptor agonists induced mydriasis in the rat by an action within the central nervous system.

1 The effects of intravenous administration of the selective alpha 2-adrenoceptor agonists clonidine, UK 14,304 and guanoxabenz on rat pupil diameter were investigated. 2 In rats anaesthetized with pentobarbitone, each agonist produced a marked dose-related increase in pupil diameter; the rank order of potency was: clonidine greater than UK 14,304 greater than guanoxabenz. 3 Pretreatment with the selective alpha 2-adrenoceptor antagonist, RX 781094 (0.5 mg/kg, i.v.), produced a parallel 30-40 fold shift to the right of the dose-pupil dilator response curves for the three agonists. Yohimbine (1.5 mg/kg, i.v.) produced about a 10 fold rightward shift of the dose-response curve for guanoxabenz. In contrast, the alpha 1-selective antagonist, prazosin (0.5 mg/kg, i.v.), failed to affect the dose-response relation for guanoxabenz. 4 Several antagonists of varying selectivities towards alpha 1- and alpha 2-adrenoceptors were tested for their ability to reverse the maximal mydriasis induced by guanoxabenz (0.3 mg/kg, i.v.). The rank order of potency of the antagonists producing a 50% reversal of this effect was: RX 781094 greater than yohimbine greater than piperoxan = rauwolscine greater than mianserin greater than RS 21361. Neither corynanthine nor prazosin reversed the guanoxabenz-induced mydriasis. 5 Topical application of RX 781094 (0.1 to 3% w/v solutions) onto one eye produced a slow reversal of guanoxabenz-induced mydriasis; the time course and degree of reversal were virtually the same in both eyes. 6 Intracerebroventricular administration of RX 781094 (1.25-15 micrograms total dose) caused a rapid dose-related reversal of the maximal mydriasis induced by guanoxabenz (0.3 mg/kg, i.v.). 7 Guanoxabenz (0.3 and 1.0 mg/kg, i.v.) did not produce any dilation of the physostigmine-constricted undamaged pupil of the pithed rat. Intravenous adrenaline was found to produce a small mydriatic effect, while atropine completely antagonized the effects of physostigmine in this preparation. 8 These results indicate that alpha 2-adrenoceptor agonists induce mydriasis in the rat through a central alpha 2-adrenoceptor mechanism. However, the site of action within the central nervous system remains to be determined.

Adrenergic alpha-Agonists↗
PubMed1996

Pupil response to tropicamide in Alzheimer's disease and other neurodegenerative disorders.

Excessive mydriatic response to dilute tropicamide has been suggested as a possible non-invasive diagnostic test in patients with Alzheimer's disease (AD). To further evaluate the sensibility and specificity of this test we studied the pupillary response to tropicamide in 24 patients with AD, 30 age-matched controls, 7 patients with dementia other than AD and 13 patients with extrapyramidal disorders (EXD). Maximum dilatation response over baseline was much higher in AD with significant differences compared to controls (p < 0.001) and to EXD (p < 0.05). However, there was a quite wide range of overlap between AD and controls and no cut-off point was found with a high enough specificity to consider this a conclusive diagnostic test. Lower dilatation response in the overlapping range (13%), however, may be useful because of its negative predictive value (93.5%) and as a screening tool due to its sensitivity (87.5%).

Aged↗
PubMed1975

Histology of the iris in geese and ducks photosensitized by ingestion of Ammi majus seeds.

Geese and ducks were photosensitized by the ingestion of Ammi majus seeds, and exposure to sunlight. Mydriasis was a characteristic clinical feature of this syndrome in both species. Histologically the iris of the affected birds showed vacuolisation and varying degrees of atrophy of the muscle of the sphincter pupillae. The effect of pilocarpine and physostigmine on the normal and mydriatic eyes was studied. The possible mode of action of photosensitization and the significance of these findings in the light of the use of psoralens in human medicine is discussed.

Animals↗
PubMed1995

Effect of sodium naproxen on inflammatory response induced by anterior chamber paracentesis in the rabbit.

This study evaluated the effect of sodium naproxen (a reversible competitive inhibitor of cyclo-oxygenase) and phenylephrine (a mydriatic alpha-adrenergic agent) eye drops in maintaining atropine mydriasis in the rabbit after paracentesis. Moreover, to assess the influence of these treatments on vascular and cellular inflammatory responses in the rabbit eye, several biochemical parameters were considered. Anterior chamber paracentesis significantly reduced atropine-induced mydriasis and a parallel elevation of proteins, polymorphonuclear leucocytes (PMNs), prostaglandin E2 (PGE2) and leukotriene B4 (LTB4) levels in the secondary aqueous humour (obtained 120 min later) was observed. A significant increase in PMNs in the aqueous humour and a parallel increase in myeloperoxidase activity, a measure of PMN infiltration, in the iris-ciliary body were detected. Atropine-induced mydriasis was maintained in rabbits treated with either sodium naproxen or phenylephrine eye drops. However, only in the former group were the inflammatory parameters significantly reduced, with the exception of aqueous LTB4 levels. The inhibition of the protein influx in the aqueous humour and of the miosis produced by sodium naproxen can be related to the high drug levels in the aqueous humour that were effective in inhibiting the cyclo-oxygenase pathway of arachidonic acid metabolism, whereas the effects on PMN infiltration appear to be independent of significant release of the potent chemotactic agent LTB4, synthesized via the 5-lipoxygenase pathway.

Analysis of Variance↗
PubMed1982

Behaviour of the fellow eye in acute angle-closure glaucoma.

A retrospective study of 245 fellow eyes of patients admitted in primary acute angle-closure glaucoma (ACG) is presented. Twenty-five (10.2%) had acute ACG in the fellow eye on presentation. Of the remaining 220, 33 (15%) subsequently developed acute ACG before prophylactic surgery was performed. Possible predisposing factors were analysed. The main findings were that acute ACG in the fellow eye occurred most frequently in hospital, or during the first month after discharge if prophylactic surgery was not performed. The instillation of mydriatics in the operated eye increased the risk to the fellow eye. Pilocarpine and carbonic anhydrase inhibitors confer the best protection on the fellow eye, but no medical regimen entirely prevented an attack of acute ACG in the fellow eye.

Acute Disease↗
PubMed1990

Topical use of indomethacin on the day of cataract surgery.

The use of topical indomethacin in the prevention of surgically induced miosis has been documented. However, in these previous prospective trials this prostaglandin synthetase inhibitor was administered the day before surgery. With the frequency of 'day case' cataract surgery increasing, an efficient preoperative mydriatic regimen is important. In this study we considered the use of topical indomethacin as an addition to a regimen already implemented. One hundred and fourteen eyes underwent intercapsular cataract surgery, of which 64 were randomised to receive topical aqueous indomethacin one hour beforehand, and 50 eyes, which did not receive indomethacin formed the comparison group. Topical indomethacin reduced the miosis which occurs during cataract surgery whether performed under local or general anaesthesia. The operating time was shorter for eyes with less surgically induced miosis.

Administration, Topical↗