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PubMed1996

Atropine versus cyclopentolate plus tropicamide in esodeviations.

BACKGROUND AND OBJECTIVE: The correction of the total hypermetropic refractive error in the management of esodeviations is well accepted. The choice of the appropriate cycloplegic agent is still not settled. Despite evidence that atropine will more effectively uncover the total refractive error, cyclopentolate in combination with other cycloplegic agents continues to be recommended. This study evaluates the use of atropine compared with a combination of cyclopentolate and tropicamide and analyzes age, size of the refractive error, and size of the esodeviation as possible contributing variables in the response. PATIENTS AND METHODS: The records of 74 patients who underwent refraction with atropine 1% on one occasion and a combination of 1% cyclopentolate and 1% tropicamide on another occasion were reviewed. The mean and range of refractive errors for each eye for each group were determined. Comparisons were made for groups depending on age, size of the refractive error, and size of the esodeviation. RESULTS: The amount of hypermetropia determined with atropine was significantly higher than the amount determined with the combination of cyclopentolate and tropicamide. This difference was significant for three age groups of three groups with increasing amounts of hypermetropia, and two groups with differing amounts of esodeviations. In addition, 11% of right eyes and 19% of left eyes showed 1.25 D or more of hypermetropia with atropine. CONCLUSION: Refraction with 1% atropine ointment yields a significantly larger amount of hypermetropia than does refraction with a combination of cyclopentolate and tropicamide. This difference is statistically significant regardless of age, amount of hypermetropia, or size of the esotropia.

Administration, Topical↗

PubMedDate not supplied

Age dependence of ocular biometric measurements under cycloplegia with tropicamide and cyclopentolate.

BACKGROUND: Cyclopentolate continues to be the cycloplegic of choice for refracting young children, although many studies of ocular biometry promote the use of tropicamide. METHODS: To clarify the role of drug type in biometric measurements, cycloplegia was induced in two disparate age groups using cyclopentolate and tropicamide on two separate occasions. Refraction, phakometry and A-scan ultrasonography measurements were made on two groups of Tibetan children resident in Nepal. RESULTS: Cyclopentolate produced significantly more cycloplegia in the younger group, which was supported by phakometry measurements. However, in clinical terms, the difference between the measurements was not significant. CONCLUSION: We conclude that although cyclopentolate is more effective than tropicamide in relaxing accommodation in young children, the use of a local anaesthetic prior to instillation of tropicamide produces refractive data virtually equivalent to that of cyclopentolate, regardless of the age group measured. However, biometric measurements may be susceptible to greater error when near fixation targets are used during phakometry procedures.

Journal Article↗

PubMed2006

[Comparative study of cyclopentolate drops versus spray in cycloplegia in children].

INTRODUCTION: Instillation of cyclopentolate drops with their irritant effect is difficult for children to bear. The purpose of this study was to compare the tolerance and efficacy of cyclopentolate spray versus drops. MATERIAL AND METHODS: The cycloplegic effect of cyclopentolate spray prepared and conditioned in the hospital was compared with drops in 62 eyes of 32 children consulting in our department. The nonparametric Wilcoxon test for paired data was used to assume there was no significant difference between the refractive measurements with spray or drops. RESULTS: The mean age of our patients was 6.3 years (SD, 3.4 years). The refractive values ranged from -17.3 diopters to +8 spheric diopters and -4 to 0 cylindric diopters. The nonparametric Wilcoxon test for paired data showed no significant difference between cycloplegic measurements with drops or spray. CONCLUSION: Cyclopentolate spray is a good alternative to traditional drops, leading to equal cycloplegic efficacy but greater tolerance in children and easier administration by the nursing staff.

Adolescent↗

PubMed1999

The comparison of cyclopentolate and atropine in patients with refractive accommodative esotropia by means of retinoscopy, autorefractometry and biometric lens thickness.

PURPOSE: In this study, we aimed to compare the cycloplegic effect of cyclopentolate HCI 1% and atropine sulphate 1% in patients with refractive accommodative esotropia by means of retinoscopy, autorefractometer and the measurement of lens thickness by biometry. METHODS: Thirty-two patients with refractive accommodative esotropia aged from 5 to 10 (mean 6.8+/-1.4), had a deviation under 10 prism diopters, and underwent retinoscopic, autorefractometric and biometric study in dry and wet conditions. RESULTS: The retinoscopic, autorefractometric and biometric findings of the right eye were 5.10+/-1.21 diopter (D), 5.03+/-1.20 D, 3.43+/-0.16 mm with cyclopentolate, and 5.2+/-1.2 D, 5.2+/-1.2 D, 3.4+/-0.1 mm with atropine. In the left eye, the measurements were 5.2+/-1.4 D, 5.1+/-1.4 D, 3.5+/-0.2 mm with cyclopentolate, and 5.3+/-1.2 D, 5.20+/-1.3 D, 3.4+/-0.2 mm with atropine, respectively. When these obtained data were compared by the Student's t test no statistical significance was found (p > 0.05). CONCLUSIONS: We suggest that the cyclopentolate cycloplegia applied to the patients with refractive accommodative esotropia is sufficient to produce good cycloplegia, with an effect similar to atropine.

Accommodation, Ocular↗

PubMed1989

[Acute psychosis caused by poisoning with cyclopentolate].

The authors report on a 17-year-old female patient who suffered an acute psychotic attack after local application of cyclopentolate 1.0% in both eyes. The literature is reviewed with regard to systemic side effects of local application of cyclopentolate. Toxicity of cyclopentolate may be found in every age group even if tolerated without side effects before and it has no specificity for patients with certain (especially brain) diseases. The rapid short-term cycloplegic effect and the rare cases of systemic toxicity support the authors opinion that cyclopentolate is a very useful and well-tolerated diagnostic substance.

Adolescent↗

PubMed1993

Plasma concentrations and ocular effects of cyclopentolate after ocular application of three formulations.

1. Eight volunteers received in randomized order two 30 microliters drops of either 1% w/v cyclopentolate hydrochloride or a corresponding amount of cyclopentolate polygalacturonate in saline or in acetate buffer in one eye. Cyclopentolate concentrations in plasma were measured by a radioreceptor assay. 2. Peak plasma drug concentrations of about 3 ng ml-1 occurred within 30 min after all formulations. Occasionally, a second concentration peak in plasma, probably reflecting drug absorption from the gastrointestinal tract, was seen after 2 h. The mean elimination half-life of cyclopentolate was 111 min when all subjects and formulations were considered together. There were no statistically significant differences between the formulations with respect to the time-course of plasma drug concentration. 3. The maximal mydriatic effect was reached within about 15 min and was maintained for several hours, often being 1/3 of its peak value after 30 h. Similarly, an intense cycloplegic response was achieved within a few minutes, the peak changes in the near-point of vision being 9 to 10 dioptres. The cycloplegic response was more intense after one of the polygalacturonate complexes, especially at later time points.

Adult↗

PubMedDate not supplied

[Cycloplegic effectiveness of cyclopentolate and tropicamide preparations compared with atropinization].

To gain a comparative estimate of cycloplegic agents with mild effect vs conventional atropinization, a study was performed on refraction in 57 children after instillations of cyclopentolate and atropine and in 57 children after instillations of tropicamide and atropine. A difference was determined in refraction after instillation of cycloplegic agents with mild effect and atropine. It turned out that by depth of cycloplegic effect cyclopentolate is reaching that of atropine. Cyclopentolate can be used in initial study of refraction in children with hypermetropic and myopic refraction and in repeated studies of any refraction. Tropicamide is less effective cycloplegic agent than cyclopentolate and thus it can be used in initial studies of refraction in children with myopia and in repeat studies of refraction in children with myopia and hypermetropia and also in cases of intolerance of other cycloplegic agents.

Adolescent↗

PubMed1989

Comparison of the effect of atropine and cyclopentolate on myopia.

We evaluated the effectiveness of cycloplegics in the treatment of myopia. Patients were selected randomly and divided into three groups: Group 1 received atropine 1% eye drops every other night; Group 2 received cyclopentolate 1% eye drops every night; and Group 3 received normal saline eye drops every night. All the patients were rechecked every three months. The results were evaluated at the end of one year. Ninety-six patients were evaluated, 32 in each group. The mean myopic progression was -0.219 D in the atropine group, -0.578D in the cyclopentolate group, and -0.914D in the saline group. Analysis showed that atropine and cyclopentolate are effective in slowing the progression of myopia. The effect of atropine is better than that of cyclopentolate.

Administration, Topical↗

PubMed1995

Influence of the time interval between instillation of two drops of cyclopentolate 1% on refraction and dilation of the pupil in children.

PURPOSE: Because the usual length of time to instill two drops of cyclopentolate 1% (five to ten minutes) is time-consuming and inconvenient to clinical staff as well as to the child and the child's parents, we investigated the influence of the time interval between the instillation of the two drops on refraction and mydriasis in children. METHODS: We conducted a crossover study on 48 children at the Tel-Aviv Medical Center. Gender, iris color, ethnic origin, and age were recorded. Two cyclopentolate 1% eyedrops were instilled at a one- or five-minute time interval. Retinoscopy was performed and the mydriatic effect was recorded. One week later, the procedure was repeated, this time with a different time interval. RESULTS: The time interval between the instillation of the two drops had no significant influence on retinoscopy results (P = .65 and P = .50 for right and left eyes, respectively) or on pupil dilation (P = .377 and P = .113 for right and left eyes, respectively). CONCLUSIONS: Instilling two drops of cyclopentolate 1% one minute apart is as effective as instilling them five minutes apart.

Child↗

PubMed1981

Cycloplegic refraction in esotropic children. Cyclopentolate versus atropine.

Retinoscopy was performed on a population of predominantly white esotropic children younger than 5.5 years with cyclopentolate 1% and atropine 1.0%. Atropine 1.0% revealed +0.34 diopters more hyperopia than cyclopentolate 1.0%, when the mean differences between the two drugs were examined. Mean difference analysis would probably indicate that atropine retinoscopy was unnecessary. However, 22% of the children had +1.0 diopters or more of hyperopia uncovered by atropine. This significant subpopulation suggests that in young patients with esotropia, an atropine refraction is essential to uncover the maximum amount of hyperopia. Almost all of this subgroup with +1.00 or greater hyperopia had an initial cyclopentolate retinoscopy of +2.00 diopters or more. Therefore, retinoscopy using atropine cycloplegia becomes even more important in this population. There was a trend for the greater differences to be in children older than age 2 years. However, these values were not statistically significant.

Accommodation, Ocular↗

PubMed2002

Changes in intraocular pressure following diagnostic mydriasis with cyclopentolate 1%.

PURPOSE: To assess the effect of diagnostic mydriasis with 1% cyclopentolate on the intraocular pressure (IOP) of patients attending glaucoma, medical retina and cataract clinics. METHODS: Levels of agreement for IOP assessment were determined and 95% of repeated readings found to be within +/-2 mmHg. The IOP of 83 cataract, 87 medical retinal and 100 glaucoma patients was measured with Goldmann applanation tonometry before and 45 min after dilatation with 1% cyclopentolate. Those showing a substantial (>10 mmHg) increase in IOP underwent gonioscopy to determine if their angles remained open and were medically treated to lower their IOP. RESULTS: An approximately normal distribution of change in IOP following dilatation was seen in all three groups (mean change 0.4 mmHg (95% CI 0.1-0.8)). The proportion of patients with a rise of 5 mmHg or more in the right eye was 7% (95% CI 4-10%). Logistic regression using all right eyes, looking at age, sex, diagnosis, ethnicity, ocular medication, iris colour and lens status (phakic/pseudophakic/aphakic) as risk factors for a rise of IOP of 5 mmHg or more did not reveal any significant contribution. Correlation between results obtained for right and left eyes in the glaucoma group was lower (0.43) than for the other groups (0.66 and 0.72), but the extent to which the direction of change in one eye predicted that in the other was shown to be high. Two glaucoma patients with open angles developed a clinically important (>10 mmHg) sustained rise in IOP requiring treatment. CONCLUSIONS: Individual variability in the effects of cyclopentolate on aqueous dynamics may account for the approximately normal distribution of IOP seen following dilatation in all three groups. This variation was in excess of that due to observation error alone. It is recommended that the IOP be rechecked after dilation in glaucoma patients with significantly damaged optic nerve heads. In medical retina and cataract patients, sustained clinically important rises in intraocular pressure following dilation seem rarer.

Adult↗

PubMed1986

Pharmacokinetics of topically applied cyclopentolate HCl and tropicamide.

The time course of accommodative loss after the topical application of 0.5% and 1.0% concentrations of cyclopentolate HCl and tropicamide was measured over a 20-min interval in 50 age- and sex-matched subjects between 20 and 30 years of age. Computer-assisted measures of residual accommodation provided detailed data on the temporal aspects of the cycloplegia induced by these commonly utilized drugs when used alone or with the topical anesthetic proparacaine HCl. The pattern of recovery of ocular accommodation from cycloplegia was also measured over a 5-h period, starting 2 h after drug application. The results show that latency, depth of cycloplegia, and rate of accommodative loss are regulated to drug type and concentration, and are influenced by the iris coloration of the test eye. The rate of onset of cycloplegia was not accelerated in blue or brown irides by the preadministration of proparacaine. Regardless of iris pigmentation, recovery from tropicamide cycloplegia was much faster than recovery from cyclopentolate cycloplegia. In contrast, the depth of cyclopentolate cycloplegia present in brown irides during the recovery phase was much greater than in blue irides. Mechanisms to explain these observations are proposed and clinical implications of these findings are presented.

Accommodation, Ocular↗

PubMed1993

1% Cyclopentolate hydrochloride: another look at the time course of cycloplegia using an objective measure of the accommodative response.

The time course of cycloplegia was measured by monitoring residual accommodation after the application of 1 drop (29.3 microliters) of 1% cyclopentolate hydrochloride. Three different measures of residual accommodation were made, one objective assessment with an optometer, and two subjective assessments similar to those used by previous investigators. Pupil diameter was also measured in a subgroup of individuals to compare the time course of the induced mydriasis to that of the cycloplegia. When residual accommodation is measured objectively, maximum cycloplegia occurs 10 min after the application of 1% cyclopentolate hydrochloride in individuals with light irides. This result suggests that the standard clinical protocol of delaying refraction 30 to 60 min after the application of cyclopentolate hydrochloride may be too conservative for individuals with light irides. For individuals with dark irides, 30 to 40 min is required for maximum cycloplegia, and the magnitude of residual accommodation in these individuals is similar to that found in light iris individuals at 10 min. When subjective measures are used to estimate residual accommodation, more accommodation is present and the time at which maximum cycloplegia occurs is delayed for individuals with light irides. These results are in agreement with previous studies using subjective techniques. Regardless of iris color or measurement method, the time course for pupil dilation is not the same as the time course for cycloplegia.

Accommodation, Ocular↗

PubMed1994

A comparison of drop instillation and spray application of 1% cyclopentolate hydrochloride.

We compared the objective cycloplegic refractive error of 37 hyperopic children (ages 18 months to 6 years). Cycloplegia was by spray application to the closed eye, or by a one-drop instillation to the open eye. Patients were initially screened for hyperopia using a masked noncycloplegic retinoscopy with loose trial lenses. Spray and drop cycloplegias (1% cyclopentolate hydrochloride; 1% Spectro Pentolate) were administered to each patient in random order within a 2-week period. A masked cycloplegic retinoscopy was performed 20 min after drug administration for patients with "light" iris coloration and after 40 min for those with "dark" irides. One examiner conducted all cyclopentolate administrations; a separate examiner (masked to application method) conducted all refractive testing. For right eyes, the mean spherical equivalent refractive error after spray application was 1.76 D (SD = 1.63 D) and after drop instillation 1.78 D (SD = 1.85 D). Results were similar for the left eyes. These small differences were not statistically significant (ANOVA, F = 0.05, p = 0.82). The absolute difference in spherical equivalent was 0.50 D or less in 93% of all subject eyes. A scaling system was used to rate the ease of administration and the patient's response to each method. Using an exact test of marginal homogeneity, the response rating for the spray method was significantly better (p = 0.038). The spray application of cyclopentolate hydrochloride is easier to administer and is an effective alternative to traditional drop instillation.

Child↗

PubMed1994

Ocular effects and systemic absorption of cyclopentolate eyedrops after canthal and conventional application.

Ocular effects and plasma concentrations of cyclopentolate were studied in 8 volunteers after eyedrop application with two methods. While recumbent two 30 microliters drops of 1% cyclopentolate hydrochloride were instilled in randomized order either conventionally to the lower conjunctival cul-de-sac or on the inner canthus with eyes closed, followed by immediate opening of the eyes. The cycloplegic responses as well as the extent and time of maximal mydriasis did not differ significantly between the two methods. None of the parameters describing the systemic absorption of the drug differed between the treatment groups. Conventionally applied drops caused slightly longer subjective discomfort. Instilling eyedrops on the inner canthus with eyes closed is an alternative method to deliver ocular cyclopentolate with similar efficacy and safety as the conventional technique. This method could be useful especially when treating non-cooperative children.

Absorption↗

PubMed1997

Cycloplegic refractions in Japanese children: a comparison of atropine and cyclopentolate.

We examined refractions of 102 eyes in 51 Japanese children after the topical instillation of cycloplegics. Cyclopentolate 1% was instilled 3 times after 5-min intervals, and refractions were evaluated 45 min after the last instillation. Atropine, 0.5% or 1%, was instilled twice daily for 7 days. Refractions were measured by an autorefractometer. The mean refraction in 102 eyes measured after atropine instillation was +3.07 dpt, and the mean after cyclopentolate instillation was +2.35 dpt. The mean difference in the direction of meridians of maximal refractions measured after atropine and cyclopentolate was 22 degrees. Our finding showed that atropine instillation may be adequate to determine exact refractions in Japanese children.

Administration, Topical↗

PubMedDate not supplied

Combination cyclopentolate and phenylephrine for mydriasis in premature infants with heavily pigmented irides.

PURPOSE: This study examined whether safe and effective mydriasis can be achieved in premature infants with heavily pigmented irides using combination cyclopentolate 0.2% and phenylephrine 1% eyedrops. METHODS: A prospective, randomized double-blind study was performed to compare combination cyclopentolate 0.2% and phenylephrine 1% eye-drops with triple instillation of tropicamide 0.5% and phenylephrine 2.5%. Twenty-eight consecutive babies with dark irides and birthweight <1600 g referred for screening for retinopathy of prematurity comprised the study population. Infants' eyes were randomly dilated twice with both regimens within a 2-week period. Blood pressure, heart rate, and pupil size were measured. RESULTS: Good mydriasis was achieved in both groups with no significant differences in pupil size or blood pressure (systolic, diastolic, or mean arterial pressures) over starting baseline values. Pulse rates decelerated below the baseline values in both groups, but these differences were not large. CONCLUSION: The single combination eyedrop of cyclopentolate 0.2% and phenylephrine 1% is as effective and safe a mydriatic for infants with dark irides as both tropicamide 0.5% and phenylephrine 2.5%.

Cyclopentolate↗

PubMed1991

Possible allergic reactions to cyclopentolate hydrochloride: case reports with literature review of uses and adverse reactions.

Cyclopentolate has been widely used as a cycloplegic and mydriatic agent for over 30 years. It has gained widespread use as the cycloplegic drug of first choice for most children over the age of 1 year and allows many optometrists and ophthalmologists to carry out quick, successful cycloplegic refractions with few complications. During this time very few side-effects have been reported with the most commonly used 1% solution. This paper outlines two cases in which a possible allergic-type reaction occurred shortly after the instillation of 1% cyclopentolate hydrochloride in 'Minims' form (Smith and Nephew). This article also reviews the uses and side-effects of cyclopentolate and aims to warn practitioners about the possibility of such reactions, ways of avoiding their occurrence and suitable measures to take should they occur.

Child↗