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Refraction of 1-year-old children after cycloplegia with 1% cyclopentolate: comparison with findings after atropinisation.

Cyclopentolate 1% is significantly less effective than atropine 1% at producing cycloplegia in 1-year-old children. If cycloplegic refraction is to be used for investigation or screening children for visual defects during the sensitive period, the more prolonged and profound cycloplegia following atropine could potentially have a disastrous effect on the development of vision. Cyclopentolate 1% would have to be used, and allowance made for its inadequacy as a cycloplegic.

Atropine↗

Cyclopentolate and grand mal seizure.

The author describes a case of grand mal seizures that occurred on two occasions after ocular instillation of cyclopentolate 2% for refraction in a 11-year old epileptic girl. The first and the second crisis developed respectively 45 and 30 minutes after instillation of the drug. Cyclopentolate should be contraindicated in known epileptic children.

Astigmatism↗

Effects of 0.1% cyclopentolate or 10% phenylephrine on pupil diameter and accommodation.

The mydriatic and cycloplegic effects of either one drop of 0.1% cyclopentolate or two drops of 10% phenylephrine were studied over a period of up to 6 hours after drug instillation, using 5 subjects aged between 25 and 43 years. The extent of mydriasis was determined from the horizontal diameter of the pupil. Dynamic accommodation responses were monitored with an infra-red, continuously recording optometer. Static measurements of the accommodation response/stimulus curve were made with a laser optometer. With either drug, dilation of the pupil occurred more rapidly than recovery of normal pupil diameter. Both drugs caused alterations in the dynamic and static accommodation responses. Response times were generally slowed, and the slope of the accommodation response/stimulus curve and the amplitude of accommodation were reduced. The time course of these changes was broadly similar to that of the pupil dilation. Cyclopentolate hydrochloride was more efficient as a mydriatic but exercised a greater unwanted cycloplegic effect.

Accommodation, Ocular↗

Adverse systemic reactions of topical cyclopentolate hydrochloride.

Systemic toxic effects of 2% cyclopentolate eye drops were studied in 66 adults. Out of these, 10 developed systemic toxic reactions. In 6 cases it was mild and in the remaining 4 cases the severity was moderate. Recovery was complete without any treatment. It is suggested that the use of 2% cyclopentolate drops should be restricted, and weaker concentrations applied with caution.

Administration, Topical↗

The cyclopentolate provocative test in suspected or untreated open-angle glaucoma. II. Clinical studies on the mechanism of intraocular pressure elevations.

The mydriasis provocative test with 1% cyclopentolate (CPT) was performed on 218 patients with suspected or untreated open-angle glaucoma, on 431 eyes in all. Significant IOP elevations (larger than or equal to 8 mmHg) were demonstrated in 21 eyes of 18 patients. The present paper analyses the responder group and presents some other investigation results and clinical findings to throw additional light on the mechanism of IOP elevation in responders. The responders did not differ from the other patients of the material in age or sex. Patients with capsular glaucoma constituted the biggest group among the responders. 48% of the significant IOP elevations during CPT were encountered in eyes with pseudoexfoliation (PE) and open-angle glaucoma. A positive response during CPT was statistically significantly more common in PE eyes than in eyes without PE. Capsular glaucoma was diagnosed immediately or later in all PE eyes which displayed a larger than or equal to 5 mmHg IOP elevation during the CPT. In addition to the importance of pigment in PE eyes, PE material may play a certain role in the elevation of IOP . The mechanism of this role is not known. No correlation was established between the results of the water drinking test and the CPT. The mechanism that causes the elevation of IOP must be quite different in these two tests. Nor was a statistically significant difference observed in the incidence of cataract, the maximal variation of IOP in the 48-h tension curve, the occurrence of cupping of the optic disc or visual field defects between the responder and non-responder eyes in the glaucomatous group.

Adult↗

The cyclopentolate provocative test in suspected or untreated open-angle glaucoma. V. Statistical analysis of 431 eyes.

The mydriasis provocative test with 1% cyclopentolate (CPT) was performed on 431 eyes with suspected or untreated open-angle glaucoma. Tonography was performed both before and during CPT to study the changes in aqueous dynamics during the test. Statistical analysis of the results yielded the following mean trends and correlations at a highly significant level (P less than 0.001) in the alterations: Intraocular pressure (IOP) rose (deltaP +/- SD) (+ 1.4 +/- 2.9 mmHg) and aqueous outflow facility decreased (deltaC) (-10%) during CPT. The distribution of deltaP and deltaC did not follow the normal Gaussian distribution. The change in deltaP deviated from the Gaussian distribution in 5-10% of the eyes. The deviating values concur with those of the responder eyes in which IOP rose greater than or equal to 8 mmHg during CPT. deltaP was linearly dependent on the initial IOP level Po and the absolute change was always almost constant, approximately +1.4 mmHg. Both the total series and the responder eyes displayed the same trend for the change in aqueous outflow facility in relation to the initial C value (Co): low Co values changed less on average and high Co values changed more and diminished. It is not known why the deltaC change was different depending on the Co value. The change in IOP correlated statistically highly significantly in the initial C value (Co). The loqwe the Co value, the higher was the mean IOP elevation during CPT. In contrast, the change in aqueous outflow (deltaC) did not corrrelate (N.S.) with the initial IOP level (Po) before CPT.

Aqueous Humor↗

[Diagnostic and therapeutic use of cyclopentolate cycloplegia].

0,5 p. 100 Cyclopentolate is an important short-acting cycloplegic and mydriatic preparation. It has the same effect on accommodation as the prolonged instillation of Atropine. Nevertheless it must be remembered that it is not a perfect cycloplegic; just as much as with Atropine resistance is frequently found in young children, in subjects with brown irides, in pigmented races, and above all in cases where there is a tonic spasm of accommodation producing functional signs or oculomotor imbalance.

Age Factors↗

[Acute psychosis after cyclopentolate-HCL (Zyklolat) (author's transl)].

Symptoms of poisoning were noticed in a eight-year-old boy after prescribed application of cyclopentolate 1 per cent (as declared by manufacturing firm). Acute psychosis disappeared spontaneous 3,5 hours later. Pharmacological analysis of the eye-drops showed that concentration of active agent wasn't 1 per cent but 1.31 per cent.

Child↗

Effect of combined 1% cyclopentolate-10% phenylephrine eye drops on systemic blood pressure of glaucoma patients.

Sixty-two patients with glaucoma had eye drops containing 1% cyclopentolate hydrochloride and 10% phenylephrine hydrochloride applied two or three times to one or usually both eyes to dilate their pupils as part of routine eye examinations. Systemic (brachial) blood pressure was monitored before and after drug application. Fifty of the patients had either no change in blood pressure or a decrease. Only two patients had a rise of 20 mm Hg or more in either systolic or diastolic blood pressure. In these two cases the increases were 34/4 and 22/20 mm Hg. Ten patients had an increase ranging from 10 to 20 mm Hg in either systolic or diastolic pressure. The results suggest that a clinically dangerous rise in systemic blood pressure from use of these drops is not common. However, to lessen the risk further, it seems advisable to use drops containing 10% phenylephrine only when lower concentrations are ineffective in dilating the pupils.

Aged↗

Systemic toxicity of cyclopentolate hydrochloride in adults following topical ocular instillation.

A case reported of a 27-year-old white woman who developed systemic toxicity after the local instillation of one drop of 2% cyclopentolate solution in each eye. The usefulness and toxic reactions of this very valuable drug are discussed. It is recommended that every ophthalmologist should warn not only the parents of the children, but also the adult patients about the possibility of systemic reaction before this drug is used and where possible the lowest concentration of solution be used. It is also suggested that a sufficient amount of injectable physostigmine salicylate be kept handy in the office emergency kit.

Adult↗