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PubMed1978

Evaluation of drugs in ointment for mydriasis and cycloplegia.

Ointment preparations of cyclopentolate hydrochloride and tropicamide were compared with aqueous drops of these medications for the production of mydriasis and/or cycloplegia in clinic patients. Mydriasis and/or cycloplegia could be accomplished by the single application of a minute volume (around 0.005 ml) of ointment containing these drugs. With the use of ointment preparation, ocular irritation was minimal, and there was no interference with subsequent ocular examination. A delivery system was devised with a piece of silicone-rubber tubing that was filled with an ointment preparation. By squeezing the tubing, a minute volume (about 0.005 ml) of ointment preparation was expressed.

Accommodation, Ocular↗

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↗

PubMed1980

Pupillary dilatation with single eyedrop mydriatic combinations.

We studied the mydiatic effect of three solutions containing a combination of two mydriatic drugs in 80 adult patients. The solutions tested were cyclopentolate HCl 0.5% with phenylephrine 2.5%, tropicamide 0.5% with phenylephrine 2.5%, and tropicamide 1.0% with phenylephrine 2.5%. We evaluated the effect of prior instillation of proparacaine 0.5% eyedrops. All three mydriatic combination solutions evaluated produced pupillary dilatation of about 7 mm within 60 minutes. Additional pupillary dilatation of 1 mm occurred when proparacaine was instilled before the mydriatic combination eyedrop. Mydriasis was resistant to bright light during indirect ophthalmoscopy in all patients. Pupils of younger patients dilated better than those of older patients, but sex and iris color were factors in the amount of pupillary dilatation obtained. Wide and sustained pupillary dilatation can be obtained for satisfactory indirect ophthalmoscopy by the instillation of one drop of proparacaine solution followed by a single drop of any of the three mydriatic combination solutions evaluated. By eliminating the need for multiple instillations of drugs, the use of a single eyedrop mydriatic combination is convenient in terms of time saved and also lessens the change of systemic drug toxicity.

Adolescent↗

PubMed1991

The oval pupil.

The dynamics of pupillary dilation induced by Phenylephrine 10% and Cyclopentolate 1% have been examined by flash photography. A correlation between anterior chamber depth and the pupil shape on dilation with Phenylephrine Hydrochloride 10% is described. It is postulated that these pupillary dilation dynamics support a sympathetic abnormality as a trigger for acute primary angle closure glaucoma.

Adolescent↗

PubMed1992

Can retinoscopy be used to screen infants for amblyopia? A longitudinal study of refraction in the first year of life.

One hundred normal babies were refracted by two observers in a double-masked study within 24 hours of delivery and 30 minutes after instillation of 1% cyclopentolate. The procedure was repeated at 6 weeks, 3 months, 6 months and 1 year. At birth agreement between the two refractionists to within 1 dioptre spherical equivalent was 82%, rising to 94% at 1 year. Astigmatism of greater than 1 dioptre increased from 10% at birth to 42% at 6 months but decreased to 15% at 1 year. Myopia was uncommon (4%) but 80% of eyes were hypermetropic more than +2 dioptres and 25% more than +4 dioptres at birth, although these percentages decreased to 5% and 3% at 1 year. Anisometropia of more than 1 dioptre between the two eyes was uncommon but in the two cases where it persisted in the presence of high hypermetropia, reversible amblyopia was encountered in both cases.

Aging↗

PubMed1995

A pre-operative mydriatic regime using a single application of tropicamide Novel Ophthalmic Delivery System and guttae phenylephrine 10%.

Tropicamide Novel Ophthalmic Delivery System (NODS) and guttae (g.) phenylephrine 10% was applied once, 2 hours before cataract surgery, as an alternative to our standard pre-operative regime of g. cyclopentolate 1% and g. phenylephrine 10% used four times before surgery. The two treatment groups were compared using a randomised, prospective, observer-masked study design. The horizontal pupil diameter was significantly smaller using the new regime but the per-operative decrease in diameter was not significantly different, suggesting that surgical miosis was not influenced by reducing the number of mydriatic applications. There was no difference in the subjective grading of the pupil, suggesting that adequate mydriasis suitable for cataract surgery was obtained using the alternative regime. No major complications were documented in relation to the use of NODS. We discuss why less intensive mydriasis is likely to be as efficacious and describe its potential advantages.

Aged↗

PubMed1995

Microbore liquid chromatography of tertiary amine anticholinergic pharmaceuticals with tris(2,2'-bipyridine)ruthenium(III) chemiluminescence detection.

The post-column chemiluminescent reaction of six anticholinergic alkaloid compounds with tris(2,2'-bipyridine)ruthenium(III) (Ru(bpy)3(3+)) is applied to microbore high-performance liquid chromatography (HPLC). At flow rates less than 200 microL/min, the capillary mixing cell in which Ru(bpy)3(3+) and the analyte are mixed directly allows for good light detection. In contrast, a diminished signal occurs at these low flow rates with conventional post-column mixing in a tee. Optimal chemiluminescent pH conditions for atropine, scopolamine, dicyclomine, cyclopentolate, cyclobenzaprine, and procyclidine are determined at moderately basic conditions (pH 7 to 9). 2-Butanone is found to be compatible with the chemiluminescent reaction, whereas tetrahydrofuran and propionitrile cause an increase in background noise and a chemiluminescent signal loss. As 2-butanone is more nonpolar than acetonitrile, it assists in the elution of these hydrophobic anticholinergic compounds. Five anticholinergic compounds are resolved successfully with a PRP-1 polymeric column and a slightly basic mobile phase, but a C8 silica column is better suited for the more hydrophobic compounds (cyclobenzaprine, procyclidine, and dicyclomine).

2,2'-Dipyridyl↗

PubMed1994

Asthenopia and the dark focus of accommodation.

To study asthenopia, we compared the dark focus of accommodation of 54 symptomatic and 56 asymptomatic control subjects. The two groups were matched for age and cycloplegic refractive error. Symptomatic subjects were defined as those who complained of asthenopia daily even though their refractive error had been corrected. Subjects with other eye diseases that could produce asthenopia such as strabismus or aniseikonia were excluded. Using a Nidek Autorefractometer AR1600, we first measured non-cycloplegic refractive error (Non-Cyclo R) in a bright room, then the dark refractive state (Dark R) in complete darkness using the instrument with the optical target light extinguished and, finally, determined the cycloplegic refractive error (Cyclo R) after instilling cyclopentolate hydrochloride. The difference between Dark R and Cyclo R was defined as DFcus (Cyclo R) and that between Dark R and Non-Cyclo R as DFcus (Non-Cyclo R). We found both DFcus (Cyclo R) and DFcus (Non-Cyclo R) to be smaller in the symptomatic than in the asymptomatic subjects, indicating that asthenopia is associated with a low rather than a high level of tonic accommodation.

Accommodation, Ocular↗

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↗

PubMed1988

Myopia prevention and therapy. The role of pharmaceutical agents. Japanese studies.

In order to normalize the condition of pseudomyopia, the following can be summarized: One percent cyclopentolate was effective in 63%, and 0.4% tropicamide was effective in 59% of the cases. With a value of 68% after labetalol eye drops there were no significant differences in efficacy between this drug and the above cycloplegics. In subjects treated only with placebo, 4 out of 16 eyes, i.e. 25% were relieved. A significant difference (P less than 0.01) was found between the results with the above 3 drugs and placebo. On the other hand, the efficacy of 0.25% timolol (effect in 28%) and chemical X (effect in 37%) were not significantly different from the effect of placebo, though the results with chemical X encourage further trials. It can be postulated that by releasing an abnormal tension cycloplegics reduce the myopic condition. Regarding the hypotensive action of beta-adrenergic blockers on intraocular pressure, it presumably depends mainly on inhibition of secretion in the ciliary body. The fact that labetalol appeared effective, and timolol not, in treatment trials of slight myopia might imply that the mechanism behind an effect of labetalol on slight myopia is not merely a beta-adrenergic blocking action.

Adolescent↗

PubMed1993

Reduction in mydriatic drop size in premature infants.

In a prospective study of 26 premature infants, 5 microliters microdrops were compared with standard 26 microliters eye drops of cyclopentolate 0.5% and phenylephrine 2.5%. There was no statistical difference in pupil dilatation. The 5 microliters microdrops have potentially fewer adverse effects in premature infants.

Cyclopentolate↗

PubMedDate not supplied

Systemic response to mydriatic eyedrops in neonates: mydriatics in neonates.

During routine dilation of 48 newborns, systemic responses and pupil dilation were monitored. Both 10 percent aqueous and viscous phenylephrine caused blanching around the eyes and produced considerable rise in blood pressure. Dilatation average 4.7 mm. In a double blind study, a 2.5 percent solution caused no skin blanching and no change in pressure or heart rate. Average dilation was 4.5 mm. No blood pressure changes were observed with either one percent cyclopentolate or one percent tropicamide. Average dilatations were 5.0 mm and 5.3 mm respectively. The above agents, used individually for a total dosage of three drops in each eye did not provide adequate dilation for a thorough funduscopic examination. Our protocol at United Hospitals Medical Center is a safe combination of drugs and provides excellent dilatation averaging greater th an 7 mm. No skin blanching or change in heart rate was observed.

Birth Weight↗

PubMedDate not supplied

Cycloplegic refraction after echothiophate iodide.

Retinoscopy under cycloplegia using cyclopentolate (Cyclogyl) hydrochloride was performed on 18 patients (36 eyes) with partial or complete accommodative esodeviation, during and after treatment with echothiophate (Phospholine) iodide. Measurements were clinically comparable on both occasions, regardless of concentration of echothiophate, duration of administration, or interval from discontinuance until refraction. It appears to be unnecessary to discontinue echothiophate iodide in order to obtain reliable cycloplegic retinoscopic measurements.

Accommodation, Ocular↗

PubMedDate not supplied

Abolition of feeding intolerance following ophthalmologic examination of neonates.

Administration of mydriatic medication and ophthalmologic examination have previously been associated with feeding intolerance, characterized by large retained gastric aspirates and abdominal distention. In an attempt to eliminate this problem, we instituted a policy of withholding feedings for four hours following ophthalmologic examination. A prospective series of 50 consecutive patients was then followed to determine the incidence of feeding intolerance 24 hours prior to and 24 hours following the examination. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride prior to the examination. A critical review of the nursing notes revealed no increased incidence in feeding intolerance during the 24-hour period following examination. There were no cases of necrotizing enterocolitis during either period. This study provides evidence that the incidence of feeding intolerance following ophthalmologic examinations might be reduced by withholding feeding for four hours after the examinations.

Cyclopentolate↗

PubMedDate not supplied

A mydriatic eye-drop combination without systemic effects for premature infants: a prospective double-blind study.

Eye drops used for diagnostic mydriasis may produce systemic side effects in preterm infants. Studies on the pupil dilating and systemic effect of various mydriatic agents yielded conflicting results. We conducted a prospective randomized double-blind study on the systemic effect of two mydriatic eye-drop combinations. Thirty-nine preterm infants were randomly assigned to two groups. An eye-drop combination of 2.5% phenylephrine and 0.5% tropicamide (group D) was compared with the combination of 0.5% cyclopentolate and 0.5% tropicamide (group F). Either eye-drop combination was followed by 0.5% tropicamide given 20 minutes later. Heart rate (HR) and the systolic, mean, and diastolic blood pressure (BP) were recorded before and after eye-drop instillation and after ophthalmoscopy. A control session with NaCl eye drops was added for each infant. A significant increase of BP and HR peak values was observed within 7 to 10 minutes after the cyclopentolate/tropicamide combination only. On the other hand, the mydriatic effect of the phenylephrine/tropicamide combination was significantly superior to that of the cyclopentolate/tropicamide combination. We recommend the combination of 2.5% phenylephrine and 0.5% tropicamide to achieve a sufficient diagnostic mydriasis without systemic side effects in preterm infants.

Blood Pressure↗

PubMedDate not supplied

[Closed angle glaucoma induced by phospholine iodide and epinephrine in a case of open angle glaucoma].

A patient suffering from open angle glaucoma was treated with topical phospholine iodide and epinephrine. Before treatment the anterior chamber was deep and the angle wide open in both eyes. Two weeks after beginning treatment there was an acute elevation of pressure to 52 mm hg in the right eye accompanied by myopia, shallowing of the anterior chamber and closure of the angle. These findings were dramatically reversed by the instillation of one drop of tropicamide and one drop of cyclopentolate. Simultaneous contraction of the dilator and sphincter muscles of the iris in this case probably caused pupillary block and closure of the anterior chamber angle, in spite of the initially wide open angle. Phospholine iodide may also have caused a spasm of the ciliary muscle and a forward movement of the lens, in a manner similar to that thought to occur in malignant glaucoma. Strong miotics together with epinephrine should be used cautiously in the treatment of glaucoma even when the initial examination shows a wide open angle.

Adult↗

PubMed1991

Autosomal recessive inheritance of myopia in Hong Kong Chinese infants.

Hong Kong Chinese infants were refracted by retinoscopy at regular intervals between the age of approximately 10 and 40 weeks. Cyclopentolate 1% was used to obtain cycloplegia. The spherical equivalent of the refractive error was calculated for each child and analysis of variance carried out according to the refractive status of the parents. From approximately 20 weeks of age a significant difference was found between the mean spherical equivalent of the refractive error of infants of parents both of whom were myopic and that of infants of parents neither of whom was myopic. At 40 weeks of age a good fit with an autosomal recessive probability model was obtained.

Adult↗

PubMed1990

[Effect of mydriasis and cycloplegia on close-range visual acuity in pseudophakia].

We have studied 21 eyes of 17 patients which underwent 3 Months before a standard extracapsular cataract extraction and implantation into the sulcus of a posterior chamber lens. All the eyes had a final uncorrected far and near vision of 0.4 (20/50) or better. We have measured the uncorrected near vision before and after pupillary dilatation with 5% phenylephrine. Then, after additional 0.5% cyclopentolate induced cyclopegia, near vision was evaluated again. Our results show a statistically significant decrease in the uncorrected near vision after pupillary dilatation (p less than 0.001). On the contrary additional cyclopegia does not significantly reduce the uncorrected near vision (p greater than 0.08). Our observations confirm the importance of unimpaired pupillary movement as regards best possible uncorrected near vision in pseudophakic patients. The activity of the ciliary muscle does not seem to mainly contribute to the phenomenon of pseudoaccommodation.

Aged↗