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PubMed1983

Effect of urea on the activity of certain ophthalmic drugs in man.

The role displayed by urea (2-10%) solutions, on the miotic and mydriatic activities of pilocarpine hydrochloride and homatropine hydrobromide respectively, was investigated on the human eye. At different concentrations, urea exerts no effect on the miotic activity of pilocarpine, whereas in the case of homatropine a negative effect is experienced. For the parameters, area under pupil diameter--time curve (AUC) and maximum pupillary response (MPR), a linear relationship exists between response to homatropine and urea concentration. However, the dependency is more pronounced in conjunction with the MPR parameter.

Drug Interactions↗
PubMed1983

Maintenance of mydriasis with epinephrine during cataract surgery.

The pupillary response to various doses of intraocular epinephrine (0.1 ml of 1:16,000, 1:32,000, 1:64,000, 1:80,000, or 1:96,000) was studied in 55 consecutive patients during extracapsular cataract surgery. The 1:16,000 epinephrine concentration provided a mean 0.74 mm increase in pupil diameter (range 0.0 to 1.7 mm) when administered to re-dilate the pupil after nucleus expression. The mean increase in pupil area with 1:16,000 epinephrine was 27% which greatly facilitated removal of lens cortex in most cases. However, 25% of all pupils failed to dilate with epinephrine 1:16,000. The other concentrations provided essentially the same mydriasis as the 1:16,000 concentration. Pupils smaller than 6 mm dilated more easily than pupils larger than 6 mm. Iris color, age, or sex had no significant effect on the mydriatic response. It is concluded that an extremely dilute concentration of epinephrine (i.e., 1:96,000 or less) may be effective in maintaining mydriasis during cataract surgery.

Aged↗
PubMed1983

Familial cases of congenital microcoria associated with late onset congenital glaucoma and goniodysgenesis.

We presented a familial case of congenital microcoria associated with late onset congenital glaucoma. The proband, a 36-year-old man, had abnormally small pupils with diameters of 3.5 mm in the right eye and 1.5 mm in the left. Mydriatics, such as 1.25% epinephrine, 5% neosynephrine, 5% tyramine, and 1% atropine did not dilate the pupils fully. The iris showed poor development of collarettes and crypts, and lacked circular contraction folds bilaterally. Gonioscopic examination revealed developmental anomalies of the anterior chamber angles in both eyes. Abundant iris processes, which fused together partially in the right and circumferentially in the left, inserted from the iris root onto the scleral spur or further near to the Schwalbe's line. Applanation tonometry measured high intraocular pressure in both eyes. The anterior chamber angle tissues obtained by trabeculectomy were studied histopathologically. In the trabecular meshwork, a thick endothelial meshwork with many layers of cells embedded in prominent extracellular materials was observed on the canal side. On the anterior chamber side, there were several layers of trabecular sheet. These findings indicate underdevelopment of the trabecular meshwork. We examined three generations of his family and found that 5 members showed bilateral congenital microcoria, and another, deceased, was said also to have had congenital microcoria. All 5 surviving patients (3 males and 2 females) with microcoria were found to have bilateral goniodysgenesis also. Two of the 5 were affected with bilateral late onset congenital glaucoma. The congenital disorders in this family, congenital microcoria and goniodysgenesis, appeared in close relation, and were transmitted by autosomal dominant inheritance.

Adolescent↗
PubMed1981

Increased blood pressure following pupillary dilation with 2.5% phenylephrine hydrochloride in preterm infants.

Heart rate and blood pressure changes following 0.5% tropicamide and 2.5% phenylephrine hydrochloride were evaluated in seven ill preterm infants (birth weight, 910 to 2,060 gm; gestational age, 26 to 36 weeks) during the first day of life. Each infant was monitored continuously for 30 minutes before and for 75 minutes after, instillation of the pupillary dilators. There were no significant changes in the heart rate, whereas a significant increase in systolic, diastolic, and mean arterial blood pressure was found. The increase in arterial blood pressure was detected at two minutes, peaked at eight minutes, and remained at significantly higher levels for 30 minutes after instillation. Because of the potential relationship between increased blood pressure and intraventricular hemorrhage, arterial blood pressure must be monitored during instillation of mydriatic drugs in the preterm infant.

Blood Pressure↗
PubMed1994

Lessons on dilation.

Mydriatics cause pupil dilation by blocking the responses to the sphincter muscle of the iris from cholinergic stimulation. Cycloplegics paralyze the action of the ciliary muscles thereby prohibiting accommodation of the lens.

Humans↗
PubMed1993

Screening for diabetic retinopathy in a clinical setting: a comparison of direct ophthalmoscopy by primary care physicians with fundus photography.

BACKGROUND: Type II diabetes mellitus is a major health problem among Native Americans, and diabetic retinopathy is a frequent complication of this disease. Screening for retinopathy can identify early disease and prevent major vision loss, but the most cost-effective screening method has not yet been determined. METHODS: In a rural clinic that served more than 400 Native Americans with diabetes, we compared the accuracy of referrals made based on two screening methods: ophthalmoscopy by trained primary care physicians and seven-view nonstereoscopic, mydriatic fundal photography read by two general ophthalmologists and a retinal specialist. Patients in whom abnormal findings were detected by either screening method were then referred to a general ophthalmologist for further evaluation. RESULTS: Two hundred forty-three examinations were performed and 83 referrals made. Both screening methods had high sensitivity for referring patients with retinopathy that required treatment or follow-up sooner than 1 year (100% for direct ophthalmoscopy by primary care physicians, 94% for the general ophthalmologist photography readers, and 100% for the retinal specialist reader). The calculated costs of screening by direct ophthalmoscopy and by retinal photography were 64% less and 44% to 35% less, respectively, than the cost of yearly ophthalmological examinations by ophthalmologists. CONCLUSIONS: Careful screening for treatable diabetic eye disease by trained primary care physicians proved to be a clinically acceptable, cost-effective strategy. Screening methods for diabetic retinopathy should be evaluated based on the absolute sensitivity, specificity, and predictive values of their ability to correctly refer patients rather than their diagnostic accuracy.

Cost-Benefit Analysis↗
PubMed1996

Iritis. How to recognize and manage a potentially sight-threatening disease.

A red eye is a common complaint, often related to benign conditions. However, a red eye in conjunction with symptoms such as photophobia, pain, and decreased visual acuity is an important clue to a much more serious disorder. Iritis is one of these but is reversible with proper use of mydriatic and cycloplegic agents and corticosteroids. Heightened clinical suspicion is necessary for timely diagnosis. The examiner should be skilled in the use of a slit lamp or should refer the patient to an ophthalmologist for immediate evaluation. Once the diagnosis is made, treatment with topical corticosteroids is imperative. Close monitoring is required because overuse of corticosteroids has ominous side effects.

Acute Disease↗
PubMed1977

Use of drugs in ointment for routine mydriasis.

The mydriatic effect produced by ointment preparations of cyclopentolate 1%, tropicamide 1%, and phenylephrine hydrochloride 10% was compared to the mydriasis elicited by the aqueous solutions of the same concentrations of drugs in children and adults. There was no difference in the amount of mydriasis produced by one instillation of a very small volume of the drug in ointment in one eye when compared to multiple instillations of the aqueous solution of the same drug in the contralateral eye in 30 minutes. There were no complaints of ocular irritation when the ointment preparations were instilled into the eye; however, there were frequent complaints with the use of these drugs in aqueous solutions.

Adolescent↗
PubMed1996

Effect of commercial dilating agents on laser flare-cell measurements.

OBJECTIVE: To compare the effect of tropicamide alone and tropicamide-phenylephrine on anterior chamber flare and cell measurements obtained with a laser flare-cell meter. DESIGN: Prospective study. SETTING: Gimbel Eye Centre, Calgary. SUBJECTS: Twenty white subjects (10 with blue irides and 10 with brown irides) aged 24 to 45 (mean 30.2) years without any known systemic or ocular disease. INTERVENTIONS: Laser flare-cell measurements were obtained 30 minutes after pupillary dilation with 1% tropicamide in one eye and a combination drop of 0.8% tropicamide and 5% phenylephrine in the other eye. The average of five readings was taken for each eye. OUTCOME MEASURES: Flare and cell measurements. RESULTS: There was no statistically significant difference in flare photon count or cell count between the eyes dilated with tropicamide and those dilated with tropicamide-phenylephrine. In addition, iris colour was not found to have a significant effect on flare and cell measurements. CONCLUSIONS: Our results suggest that pupillary dilation for laser flare-cell measurements can be done with either mydriatic agent in healthy white subjects of any eye colour without significant effects on the measurements. Further study is needed to determine whether the same is true in older subjects.

Administration, Topical↗
PubMed1976

Management of ocular foreign bodies.

Fluorescein staining is helpful in diagnosis. Many conjunctival foreign bodies can be removed by swab or irrigation, without anesthesia. Cycloplegics can prevent painful ciliary spasm. A surgical opening may be required for deeply embedded objects. Topical anesthesia is required for corneal foreign body removal. Caution: x-rays must be made to rule out intraocular foreign bodies in cases of flying metal. Rust rings must be removed. Mydriatics or cycloplegics can precipitate glaucoma. Corneal abrasions are easily infected. Secondary iritis may follow deeply embedded foreign bodies.

Anesthesia, Local↗
PubMed2003

A new fundus camera technique to help calculate eye-camera magnification: a rapid means to measure disc size.

OBJECTIVE: To find a simple means for calculating eye-camera magnification to permit estimation of true retinal object size from a retinal photograph. METHODS: The position of the focusing knob on 3 different retinal cameras (TRC-50F and TRC-50X; Topcon America Corp, Paramus, NJ; and the CR6-45NM Non-mydriatic Retinal Camera; Canon Inc, Tokyo, Japan) was measured during optic nerve photography and correlated with the refractive error, or spectacle refraction, of the subject (N = 11 for each camera). RESULTS: A strong correlation was found between focusing knob position and spectacle refraction for each of the 3 cameras tested (r = 0.96, r = 0.99, and r = 0.97, respectively). CONCLUSIONS: The focusing knob position reflects the spectacle refraction of the eye being photographed, and spectacle refraction is known to correlate well with eye-camera magnification. Therefore, focusing knob position can be used to help calculate eye-camera magnification and, hence, true retinal object size. CLINICAL RELEVANCE: The true size of the optic nerve head is important for the diagnosis of glaucoma from a retinal photograph. This technique is a simple means to calculate optic nerve head size, which may be especially useful in mass retinal photographic screening programs.

Anthropometry↗
PubMed1977

Malignant glaucoma induced by miotics postoperatively in open-angle glaucoma.

A case of malignant glaucoma that developed in a patient with primary open-angle glaucoma is described. The malignant course was induced during the immediate postoperative period by the inadvertent use of miotics. The malignant course was successfully managed by osmotic agents, acetazolamide, cycloplegics, mydriatics, and topical steroids.

Female↗
PubMed1980

Congenital Horner's syndrome.

Patients with congenital Horner's syndrome (who seemed, on the basis of their clinical history and the distribution fo anhidrosis, to have a preganglionic lesion) had partial mydriatic failure with hydroxyamphetamine hydrobromide and a supersensitivity to phenylephrine hydrochloride. This apparent paradox can be readily explained by postulating an aorthograde transsynaptic dysgenesis of the postganglionic neuron, such as has been demonstrated in the sympathetic nervous system of newborn animals. The failure of hydroxyamphetamine to cause mydriasis indicates damage to the postganglionic sympathetic neuron, but in the neonate this damage may be secondary to a preganglionic lesion.

Child↗
PubMed1997

Topical 0.5% ketorolac vs 0.03% flurbiprofen for inhibition of miosis during cataract surgery.

OBJECTIVE: To compare the effects of topical 0.5% ketorolac tromethamine ophthalmic solution (Acular, Allergen Pharmaceuticals, Irvine, Calif) with topical 0.03% flurbiprofen sodium ophthalmic solution (Ocufen, Allergen Pharmaceuticals) on the inhibition of surgically induced miosis during phacoemulsification cataract surgery. DESIGN: One hundred eighteen patients were prospectively randomized to receive 0.5% topical ketorolac or 0.03% topical flurbiprofen at 3 preoperative intervals. The flurbiprofen-treated group served as the control group. The surgeon was masked as to patient selection. Horizontal pupillary diameter measurements were obtained at the start of surgery, just before phacoemulsification, before lens implantation, and after lens implantation. RESULTS: Mean horizontal pupillary diameter measurements for both medications were similar at the start of surgery. However, a consistent trend of larger pupillary diameter was seen in all subsequent surgical intervals in the ketorolac-treated group. Changes from baseline measurements also indicated a more significant inhibition of miosis at all subsequent intervals, and a more stable mydriasis throughout the procedure in the ketorolac-treated group. CONCLUSIONS: Topical ketorolac is an effective inhibitor of miosis during phacoemulsification cataract surgery, and provides a more stable mydriatic effect throughout the surgical procedure.

Administration, Topical↗
PubMed1985

Feeding intolerance following ophthalmologic examination.

Reports of isolated cases of necrotizing enterocolitis following administration of mydriatric medication and ophthalmologic examination prompted a comparison of the incidence of feeding difficulties 24 hours before and 24 hours after the ophthalmologic examination of 50 newborns. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride before the examination. A critical review of the nursing notes showed more abdominal distention and gastric aspirates in the period following the examination than in the period preceding the examination. One infant developed necrotizing enterocolitis during the 24-hour postexamination period. This study demonstrates the risk of feeding intolerance following the ophthalmologic examination of neonates. These risks may be due to the known side effects of the mydriatics, to the physical stress of the examination, or to a combination of both factors.

Animals↗
PubMed1975

A comparison of fenfluramine and amphetamine in man.

dl-Fenfluramine hydrochloride (60, 120, 240 mg), d-amphetamine sulfate (20, 40 mg), and placebo were compared in 8 postaddict volunteers, each dose given orally in random sequence at weekly intervals using a double-blind crossover design. Fenfluramine had little effect on blood pressure and temperature, but caused a marked dilation of pupils, whereas amphetamine was a potent vasopressor and a weak mydriatic. While fenfluramine produced euphoria in some subjects, its overall effects were unpleasant, sedative, and qualitatively different from amphetamine. Three subjects given 240 mg of fenfluramine experienced brief but vivid hallucinogenic episodes characterized by olfactory, visual, and somatic hallucinations, abrupt polar changes in mood, time distortion, fleeting paranoia, and sexual ideation. These observations indicate that fenfluramine is a hallucinogenic agent with a pharmacologic profile in man that is not amphetamine-like.

Adult↗
PubMed1986

Ocular oxygenation: the effect of phenylephrine on anterior chamber oxygen tension.

Phenylephrine preparations are widely used in medicine for their vasoconstrictive and mydriatic effects. The effect of phenylephrine, a powerful alpha-receptor stimulant, on anterior chamber oxygen tension (Po2) was studied using a polarographic electrode inserted into the mid anterior chamber of cats. A commercial 10% solution was applied topically. A decrease in anterior chamber Po2 was usually observed in 8-24 minutes and declined steadily thereafter. Prior to treatment, the mean anterior chamber Po2 was 26 +/- 3 torr; 1/2 hour after treatment it decreased to 20 +/- 7 torr. After 1 hour it dropped to 13 +/- 8 torr and was further reduced to 11 +/- 6 torr by 2 hours. By 90 minutes, the drug had caused a 58% reduction in anterior chamber oxygen tension. This drop is similar to that reported for epinephrine. It is suggested that the mechanism for most of this decrease is reduced blood flow, mediated by the direct vasoconstrictive effect of the drug in addition to compression of the iris vasculature induced by dilation. The resulting change (reduction) in caliber of the iris arteries produces a parallel change (reduction) in blood volume and flow resulting in a diminished Po2. The clinical implications of this conclusion in disorders where hypoxia is felt to play a causal role such as neovascular glaucoma, diabetes, pregnancy and hyphema in sickle cell disease are explored.

Administration, Topical↗
PubMed1991

Extrapyramidal disturbances after cyanide poisoning (first MRT-investigation of the brain).

A 29 year old student of chemistry took 50 ml of a 1% potassium cyanide solution (500 mg) in attempted suicide. He became comatose, mydriatic and was admitted to hospital in an apneic state. He woke up after seven hours and developed Parkinsonism in the following weeks. This regressed slowly in the second month after the poisoning apart from dysarthria, bradykinesia of the upper limbs and very brisk monosynaptic reflexes. Three weeks after the intoxication, CCT was largely normal, and there was CSF-dense hypodensity in both putamina after five months. Sharply delimited signal elevation in T2 corresponding to the two putamina was detected in the MRI eight weeks and five months after ingestion of the poison.

Adult↗