Dilating Eye Drops Research Articles

Tamarind seed polysaccharide (TSP) uses in ophthalmic drug delivery

At present, ophthalmic drug delivery remains a major challenge, given the eye's prot ective structure and susceptibility to irritation, resulting in poor patient adherence. In order to overcome these constraints, new formulations are continually being developed. The inclusion of Galactoxyloglucan (Tamarind seed polysaccharide (TSP) in such formulations, a natural substance extracted from the seeds of Tamarindus indica, has shown great potential due to its physico - chemical properties, high biocompatibility and safety profile. Such properties, have led to its use in formulations for the treatment of dry eye disease, glaucoma, and bacterial keratitis, as well as in dilating eye drops used in eye examinations. In this article, we highlight the most recent TSP - based ophthalmologic formulations, which indicate that this polymer is a strong candidate to reduce adverse effects, improve patient tolerability and drug bioavailability.

Implementation of Novel Protocols in an Ophthalmic Ambulatory Surgical Center to Resume Surgical Procedures During COVID-19.

With the resumption of elective ophthalmic surgery during COVID-19, revised protocols were mandated to protect both staff and patients from transmission while increasing case numbers. We discuss a widely generalizable and in-depth protocol intended to safely allow the restart of elective procedures in 2 dedicated ophthalmic ambulatory surgical centers (ASCs) using monitored anesthesia care. A single-center review of protocols and practices designed to limit COVID-19 transmission. All patients were tested within 72 hours prior to the procedure with a COVID-19 nasal swab to assess for active disease. A distance of 6 ft between each stretcher and the staff within the ASC was maintained when possible. Preoperative anesthetizing and dilating eye drops were administered from multiuse bottles without contact with surfaces. Surgical cases were restarted at a reduced capacity of a maximum of 7 per day to distance patient arrivals. Removal of waiting room chairs and the creation of new break areas allowed for social distancing. As recommendations change on the basis of an increased understanding of the COVID-19 virus, ophthalmologists and ASC staff need to tailor protocols and workflows to limit transmission of virus with resumption of ocular surgery.

Hemodynamic Changes Associated with Mydriatic Eye Drop Administration in Anesthetized Pediatric Patients

Background: Dilating eye drops are routinely used in pediatric retinoblastoma patients during anesthetized ophthalmologic exams. Information on the systemic effects of ocular mydriatics, especially in anesthetized pediatric patients, is limited. Objective: The primary aim of this study was to analyze hemodynamic changes during mydriatic eye drop administration in anesthetized pediatric patients. Methods: A retrospective chart review was performed for pediatric retinoblastoma patients who underwent MRI with anesthesia. Baseline blood pressure (BP) and heart rate (HR) were charted for each patient at induction. HR and mean arterial pressure (MAP) measurements were recorded at 5, 10, 15, 30, and 45 min after eye drop administration. Secondarily, we included data from 15 patients who received dilating eye drops while under sevoflurane general anesthetic. All patients were dilated with phenylephrine 2.5 or 10% (depending on age) and tropicamide 1%. Results: The final analysis included 176 anesthesia encounters. The results demonstrate no statistically significant deviation of more than 20% from baseline for either HR or MAP. Additionally, we did not detect any difference between patients who were anesthetized with propofol versus sevoflurane. Conclusions: We did not observe significant hemodynamic instability with administration of dilating eye drops during propofol anesthesia.

Budget impact model of Mydrane\xae, a new intracameral injectable used for intra-operative mydriasis, from a UK hospital perspective

BackgroundDuring cataract surgery, maintaining an adequate degree of mydriasis throughout the entire operation is critical to allow for visualisation of the capsulorhexis and the crystalline lens. Good anaesthesia is also essential for safe intraocular surgery.Mydrane® is a new injectable intracameral solution containing two mydriatics (tropicamide 0.02% and phenylephrine 0.31%) and one anaesthetic (lidocaine 1%) that was developed as an alternative to the conventional topical pre-operative mydriatics used in cataract surgery. This study aimed to estimate the budget impact across a one year time frame using Mydrane® instead of topical dilating eye drops, for a UK hospital performing 3,000 cataract operations a year.MethodsA budget impact model (BIM) was developed to compare the economic outcomes associated with the use of Mydrane® versus topical drops (tropicamide 0.5% and phenylephrine 10%) in patients undergoing cataract surgery in a UK hospital. The outcomes of interest included costs and resource use (e.g. clinician time, mydriasis failures, operating room time, number of patients per vial of therapy etc.) associated with management of mydriasis in patients undergoing cataract surgery. All model inputs considered the UK hospital perspective without social or geographical variables. Deterministic sensitivity analyses were also performed to assess the model uncertainty.ResultsIntroduction of Mydrane® is associated with a cost saving of £6,251 over 3,000 cataract surgeries in one year. The acquisition costs of the Mydrane® (£18,000 by year vs. £3,330 for eye drops) were balanced by substantial reductions in mainly nurses’ costs and time, plus a smaller contribution from savings in surgeons’ costs (£20,511) and lower costs associated with auxiliary dilation (£410 due to avoidance of additional dilation methods). Results of the sensitivity analyses confirmed the robustness of the model to the variation of inputs. Except for the duration of one session of eye drop instillation and the cost of Mydrane®, Mydrane® achieved an incremental cost gain compared to tropicamide/phenylephrine eye drops.ConclusionsDespite a higher acquisition cost of Mydrane®, the budget impact of Mydrane® on hospital budgets is neutral. Mydrane® offers a promising alternative to traditional regimes using eye drops, allowing for a better patient flow and optimisation of the surgery schedule with neutral budget impact.

Adenovirus-related epidemic keratoconjunctivitis outbreak at a hospital-affiliated ophthalmology clinic

Adenovirus-associated epidemic keratoconjunctivitis (A-EKC) is a cause of large and prolonged outbreaks in ophthalmology clinics and can result in substantial morbidity. A-EKC outbreaks are often the result of contaminated ophthalmologic equipment, surfaces, or hands. Contaminated multidose eye drops are also a likely culprit, but few prior studies provide clear epidemiologic evidence that adenovirus transmission resulted from contamination of eye drops. We describe an A-EKC outbreak at a large, hospital-affiliated eye clinic that affected 44 patients. The unique epidemiology of the outbreak provides strong evidence that contaminated multidose dilating eye drops resulted in adenovirus transmission. Removal of multidose eye medication from the clinic, combined with case finding, enhanced infection control and enhanced environmental cleaning, led to rapid control of the outbreak.

Knowledge, attitude, and practice of diabetic retinopathy among physicians in Northwestern Nigeria

Diabetic retinopathy (DR) is the leading cause of preventable blindness in the productive population that poses a considerable global public health burden. The objective of this study is to assess the knowledge, attitude, and practice of DR screening among physicians in Northwestern Nigeria. Materials and Methods: Survey responses were obtained from 105 physicians in 4 tertiary hospitals using a Likert scale questionnaire. The internal consistency of the questionnaire was calculated using Cronbach's alpha coefficient. Principal component analysis was used for data reduction and grouping with the varimax rotation method, and the factors were extracted based on an Eigenvalue> 1. Most of the respondents (78.8%) were aware of the most effective method of delaying the onset of DR and frequency of eye examination (94.1%). Lack of ophthalmoscopes (70.6%) and dilating eye drops (50.6%) form important barriers to performing a good eye examination. DR screening among physicians practicing in Northwestern Nigeria was suboptimal, which prompts the need for improved training of physicians managing persons with diabetes on eye examination in a bid to strengthen DR screening and reduce the burden of visual impairment in our environment.

A 5-Minute Interval between Two Dilating Eye Drops Increases Their Effect.

Patients are usually advised to wait 5 minutes between eye drops. This delay supposedly allows the first drop not to be washed out by the second one, thereby increasing the combined effect. However, in the only experimental study conducted in humans on the concurrent administration of two different eye drops, the authors concluded that a 10-minute time interval between eye drops did not increase their combined effect. Our study was designed to address this puzzling observation. Using digital photographs shot in photopic conditions in 40 eyes of 20 healthy volunteers, we compared relative pupil surface (i.e., pupil to iris surface area ratios) before and after the administration of one drop of 10% phenylephrine and one drop of 0.5% tropicamide either immediately or after a 5-minute time interval. Waiting 5 minutes yielded a 5.6% relative pupil surface gain (observer 1: P = .003, observer 2: P = .005) indicating an additional combined effect with a 5-minute time interval. These results show a detectable additive effect that is probably the result of methodological refinements including the challenging of the mydriasis by photopic conditions and the use of pupil and iris surface areas, which may show differences that would be undetectable in terms of diameter.

Epileptic seizures induced by cycloplegic eye drops

Objective: To assess the incidence of seizures induced by cycloplegic ophthalmic drops.Materials and methods: A survey among members of the American Association for Pediatric Ophthalmology and Strabismus yielded five patients who received cycloplegic eye drops between 1998 and 2010 and who consequently developed a seizure.Results: The median age of the patients was 5 years (range 3 months to 12 years). Cyclopentolate hydrochloride 1% was the only causative agent. The seizure happened on average 12 min after the instillation of dilating eye drops. Three were generalized convulsions, and two patients had a focal seizure. Past medical history was unremarkable in four cases. In total, 16 previous cases of seizures induced by cycloplegic drugs were identified in reports published between 1890 and 2004, implicating atropine in nine reports, tropicamide and phenylephrine eye drops in one and cyclopentolate in six.Discussion: A small amount of cyclopentolate drops could induce convulsions in young children after only minutes to less than an hour, while a larger dosage of atropine over the span of several hours could cause this rare and unpredictable complication. Predisposing factors were rare and those developing the seizures were healthy subjects. Generalized seizures were much more frequent than focal convulsions.Conclusions: Seizures after instillation of cycloplegic drops are extremely rare.

962 Thiopentone Infusion in ICU- There is More to this Than Meets the Eye

Thiopentone infusion is used to manage patients with Traumatic Brain Injury with persistent raised Intracranial pressure (ICP) and in treating intractable seizures. Pupillary abnormalities (unequal or fixed and dilated) can...

Practice and Knowledge of Funduscopy by Medical Practitioners in Owo, Nigeria

Aim: This study was carried out to determine the practice of funduscopy by medical practitioners and also identify possible barriers to it in a Nigerian community.Methodology: The study was conducted in March and April 2008 at the Federal Medical Centre, Owo, Ondo State, Nigeria. Eighty medical practitioners were selected by simple random sampling and interviewed with the aid of a questionnaire. Information obtained included biodata of the respondents, practice of funduscopy, barriers to the practice offunduscopy, as well as the use of dilating eye drops for funduscopy.Results: More than half of the respondents (58.8%) practiced funduscopy while the remaining 41.3% did not. Most respondents (89.4%) who practiced funduscopy did so rarely. The majority of the respondents (88.8%) expressed a desire for further training in funduscopy. The barriers to the practice of funduscopy were mainly lack of skills (30%) and lack ofaccess to an ophthalmoscope (28.8%). Very few respondents (7.5%) used topical mydriatics for funduscopy. The level of experience and of the respondents significantly affected the practice of funduscopy with a p value of 0.032.Conclusion: More than half of the respondents performed funduscopy, however most of them did so rarely. The barriers to the practice of funduscopy include lack of skills and access to an ophthalmoscope.

Epstein-Barr virus and acute retinal necrosis in a 5-year-old immunocompetent child

To describe a case of bilateral acute retinal necrosis syndrome (ARNS) in a 5-year-old boy. A retrospective, interventional case is described in one child attending the pediatric ophthalmology section, complaining of sudden bilateral red eye and haze-impaired vision. A standardized ophthalmologic examination and specific serological probes supported the diagnosis of severe bilateral ARNS in an immunocompetent child. The reduced visual acuity (<20/400), the ocular fundus signs (perivasculitis, thrombosis and retinal edema) and the positive immunoglobulin M anti-Epstein Barr virus serology, lead us to the ARNS definitive diagnosis. Antiviral therapy (Acyclovir; Zovirax((R))), ciclopentolate dilating eye drops, and antiplatelet treatment (acetil salicylic acid; Aspirin((R))) were administered until recovering the final visual acuity (20/40). The ARNS is an ocular disease with poor prognosis, which in turns may display better course when determining the etiopathogenic virus and selecting the appropriate and precocious therapy.

Patients’ attitudes towards mydriasis for diabetic eye disease screening

The purpose of the questionnaire was to explore attitudes of patients towards mydriasis for diabetic retinopathy screening. Two groups of patients were invited to take part: group 1 comprised patients attending the diabetic clinic and had previous experience of mydriasis, group 2 patients attending the mobile screening unit for non-mydriatic digital retinal photograph and who were not previously used to receiving mydriatic eye drops. Basic demographic data was recorded and the volunteers invited to complete a questionnaire. 292 patients were recruited into group 1 (median age 63 years range 20-94) and 103 into group 2 (median age 68 years range 29-96). 42% of patients in group 2 indicated that they were unhappy with the use of dilating eye drops and 26% of this group reported that they may be discouraged from attending screening for diabetic retinopathy if drops were introduced. These figures were statistically lower in group 1 at 8% and 1-8% respectively (p < 0.001). Blurring of vision was identified as the most troublesome feature of the use of mydriasis for patients. A large proportion of patients drove themselves to their last screening appointment; 58% in group 2 and 39% in group 1. A third of all patients (33%) indicated that they worked outside the home. Many patients attending diabetic eye screening return to driving and work immediately after the appointment. Introduction of the use of routine drops may discourage attendance. Education and experience may have an important role in improving acceptability of mydriatic eye drops. Retinal screeners need to have clear guidelines with which to advise patients.

Abstracts

Abstracts

A national retinal screening programme for diabetes in Scotland.

The Health Technology Board Scotland (HTBS) have issued recommendations for eye screening in patients with diabetes. These are based on evidence-based clinical studies. Evidence-based studies do not answer all the practical issues, and some conclusions have thus been extrapolated from the known evidence base. Other factors such as patient issues, organizational issues and cost effectiveness have also been incorporated into the recommendations. HTBS recommend single-field digital retinal photography. Retinal photography best addresses the issues of adequate sensitivity and accountable quality assurance. Non-mydriatic photography is recommended, followed by immediate use of dilating eye drops if it is unsuccessful, followed by slit-lamp examination if both of these approaches fail. An independent grading scheme has been established, which is similar to the 'Global', and compatible with the National Screening Committee (NSC) grading scheme. The rationale for these recommendations, and debate behind some of the decisions, is laid out in this article.

Ocular medications in children.

Many ocular medications are used by pediatricians or ophthalmologists caring for pediatric patients. Topical antibiotics are commonly prescribed for bacterial conjunctivitis, nasolacrimal duct obstructions, and ophthalmia neonatorum. Many new antiallergy eye drops are now available for the treatment of seasonal (hay fever) conjunctivitis. Dilating eye drops and antiglaucoma medications are generally used or prescribed by ophthalmologists, but pediatricians must be aware of their potentially serious systemic side effects. Before initiating treatment, physicians should evaluate the risks and benefits of ophthalmic medications, establish minimum dosages necessary to achieve a therapeutic benefit, and monitor children for local and systemic side effects.

Visual recovery using small dilating eye drops.

It is well established that reduced size dilating eye drops of 1% tropicamide and 10% phenylephrine (micro drops) are effective for clinical purposes. Excellent pupil dilatation (mydriasis) is achieved and pupil constriction does not occur in response to light. In this study, the effect of micro drops of 1% tropicamide on distance and near visual recovery was compared with standard drops in a group of 20 healthy volunteers. For each person studied, one eye was selected at random to be tested first with the standard drop size, and then after a minimum of one week, the same eye was again tested using a drop of the same drug one fifth standard size. An iris photograph, Snellen visual acuity at 6 m, and reading visual acuity was obtained for each test procedure: before drop instillation and at 30 min, 1, 2 and 4 h after drug instillation. Use of the micro drops caused a small but statistically significant improvement in the rate of recovery of distance and near visual acuity. These findings, allied to the known beneficial effects of reduced systemic absorption using micro drops, lend further weight to the argument that mydriasis may be achieved more safely, with fewer side effects, and with earlier return of normal vision when reduced size drops are used. It is hoped that practical micro drop dispensers will be developed.

Pediatric ophthalmic mythology.

Headaches in children are virtually never the result of eye problems. If a child needs glasses, young age is almost never a contraindication to their use. Any child in whom strabismus is recognized or suspected should be referred to an ophthalmologist. The strabismus may be a presenting sign of a serious disease. Even if it is not, spontaneous cure almost never occurs. Furthermore, the younger the child, the easier and more successful will be the treatment of both the strabismus and the amblyopia that often accompanies it. Dyslexia is not the result of abnormalities of the eyes and is unaffected by eye exercises. There are no significant ocular hazards in the use of standard mydriatic (dilating) eye drops in children.