Phenylephrine Eye Drops Research Articles

A new algorithm for the transconjunctival correction of moderate to severe upper eyelid ptosis in adults

A posterior approach is recommended for the correction of mild to moderate upper eyelid ptosis in adults. The aim of this study is to propose a new algorithm that helps to predict outcomes in the transconjunctival correction of moderate to severe blepharoptosis. This study included adult patients with moderate to severe upper eyelid ptosis treated between 2019 and 2021. Patients meeting inclusion criteria underwent ptosis correction through a posterior approach using an algorithm: 4 mm Mueller’s muscle transconjunctival resection to correct 1 mm ptosis (depending on a test with 10% phenylephrine: 3–12 mm) ± tarsal plate resection: 1 mm for every 1 mm of residual ptosis after phenylephrine test, but leaving a minimum of 4 mm upper tarsus intact. Outcomes were ovserved within at least 6-months. Outcomes were assessed based on pre- and postoperative MRD1 changes, inter-eyelid height symmetry, cosmetic effect, and complications. Outcomes of 118 procedures in 81 patients (average age 69, range: 47–87) were analyzed. MRD1 changes were statistically significant, from 0.2 ± 1.6 mm before to 4.1 ± 1 mm after surgery. The function of the levator palpebrae superioris muscle was 10.2 ± 3.4 (range 5–17) mm. Upper eyelid lifted by an average of 1.8 ± 0.7 (range 0–3) mm after the instillation of 10% phenylephrine eyedrops. An average of 8.5 ± 0.8 (range 8–10) mm of conjunctiva and Mueller’s muscle and 2.2 ± 0.9 (range 1–5) mm of the tarsal plate were resected during the procedure. Inter-eyelid height symmetry within 1 mm was achieved in 95% of outcomes. The algorithm introduced in this study appears to be useful to achieve repeatable satisfactory outcomes in the transconjunctival correction of moderate to severe upper eyelid ptosis in adults with at least ”fair” levator function.

Evaluation of Tropicamide-Phenylephrine Mydriatic Eye Drop Instillation on Choroidal Thickness.

The purpose of this study is to evaluate choroidal thickness (ChT) at the subfoveal and peripheral level after the instillation of 0.5% tropicamide + 10% phenylephrine 9 hydrochloride eye drops by using OCT scans in enhanced depth image (EDI) mode. In total, 53 patients (30 males and 23 females) were involved, and the mean age was 25.62 ± 2.41 (age range: 23-36). The dominant eye was treated with tropicamide + phenylephrine (Visumidriatic Fenil 100 mg/mL + 5 mg/mL, Visufarma) while the nondominant eye was used as the control. An OCT analysis was performed on both eyes before and 30 min after the instillation of a drop of mydriatic in the dominant eye. The ChT was measured by using the OCT software measurement tool (Spectralis; Heidelberg Engineering; Heidelberg, Germany, version 6.0). The results showed a statistically significant ChT decrease (p = 0.009) in the temporal sector after the treatment with tropicamide + phenylephrine. In the subfoveal and nasal sectors, no statistically significant ChT changes were detected (p = 0.94; p = 0.85) following the administration of the mydriatic eye drops. The ChT thinning in the temporal sector following the instillation of the tropicamide + phenylephrine eye drops suggests that in the case of ChT studies, mydriatic administration should be avoided.

COMPARISON OF THE DILATING EFFECT OF THREE MYDRIATIC AGENTS ON DARK IRIDES

Dilation of pupil has been a major component of diagnostic eye examination inOptometric practice. Although mydriatic agents are used in clinical procedures, thereis no satisfactory explanation for the preference of one over another. This studycompared the dilating effect of three different mydriatic agents on dark irides ofninety healthy subjects; comprising 48 males and 42 females aged 16-30 (mean age18.77±0.52) years divided into three groups of 30 subjects each. One drop of 1%tropicamide eye drop was instilled into the right eye of Group 1 subjects, One drop of1% homatropine eye drop was instilled into the right eye of Group 2subjects, whileOne drop of 2.5% phenylephrine eye drop was instilled into the right eye of Group 3subjects, The left eye (control eye), received a placebo of one drop of 10mg/mlBenzyl Alcohol in all the subjects in the three groups. Baseline measurements wererecorded prior to instillation, thereafter mydriatic effect was assessed over a periodof 40 minutes starting at 5 minutes and thereafter at 10 minute interval using thehand held pupillometer. Results showed that after 40 minutes of instilling the 3mydriatic agents to the right eyes, there was a statistically significant difference(p<0.05) in the pupil diameter of all the subjects in the three groups .Maximum meanpupillary dilation was 7.10±0.27mm, 6.00±0.56mm, and 4.80±0.36 mm for 1%tropicamide, 1% homatropine, and 2.5% phenylephrine respectively after 40minutes. Therefore it can be concluded that significant differences exist in themydriatic effect of the three mydriatic agents.

A Comparison of the Mydriatic Efficacy of Tropicamide and Phenylephrine Eye Drops Administered as a Vaporized Spray in One Eye and Conventional Drop Instillation in the Other Eye in an Indian Pediatric Cohort.

To determine by serial measurements and compare the pupillary mydriasis effect of tropicamide and phenylephrine drops administered as a vaporized spray over closed lids in one eye and through conventional instillation of eye drops in the other eye in a pediatric cohort. This prospective study was conducted on healthy children aged 6-15 years. After visual assessment, investigator 1 examined the child for initial pupillary size. Investigator 2 instilled the drops in one eye and applied the spray to the other eye randomly, and the response of the child was noted using the Wong-Baker pain rating scale. The eyes receiving the spray and the eyes receiving drop instillation were considered as Groups 1 and 2, respectively. Subsequently, serial pupillary measurements were carried out every 10 min for up to 40 min by investigator 1. The patient compliance for the two methods of drug instillation was also compared. The study comprised 80 eyes. At 40 min, both the groups showed no statistical difference in the mydriasis effect, with Group 1 showing 7.23 mm mydriasis and Group 2 showing 7.58 mm (P = 0.058). The analysis of the pain rating scale showed better compliance with the spray method of drug instillation, which was statistically significant (P = 0.044). Our study shows that spray application is a less invasive method for pupillary dilatation, which has better compliance and provides equally good dilatation as conventional methods. This study proves the efficacy of spray application in an Indian pediatric cohort.

CLINICAL AND FLUORESCEIN ANGIOGRAPHIC CHARACTERISTICS OF FEATURELESS RETINA IN DIABETIC RETINOPATHY

Introduction: Diabetes retinopathy is a leading cause of blindness. According to "Statistics on blindness in the Model Reporting Area 1969-70," diabetic retinopathy was responsible for 11.1% of all new cases of legal blindness and 19.1% of those aged 20-64 years. The study objectives were to investigate diabetic retinopathy in the context of age of onset of diabetes, duration of diabetes, and metabolic control, to investigate the relationship of diabetic retinopathy with age and gender of the patients, to investigate the different stages of retinopathy and their analysis, and to investigate the benefits of fluorescein angiography. Methods: This one-year retrospective study was carried out at SCB Medical College, Cuttack, Odisha. After pupillary dilatation with a combination of phenylephrine and tropicamide eye drops (e.g. Tropicacyl plus eyedrops), the initial examination began with a fundus inspection with a direct ophthalmoscope. To avoid cardiovascular problems, effort was taken to rule out hypertension in the patient before administering these eyedrops. Results: The current study included data from 50 diabetic patients who visited SCB Medical College, Cuttack, Odisha outpatient department or were hospitalised within a one-year period. Conclusion: Fundus Fluorescein Angiography is a valuable auxiliary diagnostic method. The procedure is useful in the diagnosis, treatment, documentation, and follow-up of patients, as well as in keeping a permanent record of the stages of retinopathy, which is useful in understanding the course of the disease in the patient, as well as the patient's response to treatment and follow-up.

Implications of Diagnostic Drops on Scheimpflug Tomography: The Proper Order for Clinical Testing.

The purpose of this article was to study the impact of instillation of 1% fluorescein and mydriatics on measurements made by Scheimpflug imaging. This was a cross-sectional study of patients who had measurements of corneal shape (maximum keratometry and best fit sphere of anterior and posterior corneal surfaces), pachymetry (at the pupil center, corneal apex, and thinnest location), and anterior chamber parameters (depth, volume, and angle of anterior chamber and corneal volume) using the Pentacam HR before and after the instillation of fluorescein and mydriatics. Group A had baseline measurements that were repeated 1.5 hours after the instillation of 1% fluorescein and 0.8% tropicamide+ 5% phenylephrine eye drops. Group B had baseline measurements that were repeated 10 minutes after the instillation of 1% fluorescein, and group C had baseline measurements that were repeated 1.5 hours after the instillation of mydriatics. Overall, 131 eyes of 131 patients were studied: 87 in group A, 28 in group B, and 16 in group C. Significant differences and wide variations were noted in corneal pachymetry and anterior chamber parameters in all 3 groups. The highest magnitude and range of difference was observed in pachymetry at the pupil center (17 ± 53.5 μm) and in anterior chamber volume (26.7 ± 69.8 mm 3 ). Corneal shape measurements of anterior and posterior corneal surfaces were not significantly affected by either fluorescein or mydriatics. Pupillary dilation also affected the ability of the Pentacam to accurately trace the pupil margin in 19.5% of cases. For consistent and accurate measurements, it is important that Scheimpflug imaging be performed before other tests which may need the instillation of fluorescein or mydriatics.

Intraoperative Cardiovascular Instability in a Child Following Instillation of Phenylephrine Eye Drops

Introduction: The use of topical mydriatics is well described in ophthalmic surgery, one of these being phenylephrine eye drops which are available in 1%, 2.5% and 10% solutions. They are classically used to improve operating conditions but there have been recurrent concerns regarding serious adverse reactions as a direct consequence of systemic absorption. Case Reports: We present the case of a 10-year-old boy who presented for eyelid laceration repair and examination under general anaesthesia of the eye, after a severe dog bite injury. Shortly after instillation of 10% phenylephrine eye drops, the anaesthetist noticed a sudden bradycardia associated with profound hypertension. Surgery was temporarily stopped, volatile anaesthetic reduced and atropine boluses administered. Within minutes, blood pressure and heart rate normalized. The administration of the eye drops was determined to be the cause of this haemodynamic instability. Conclusion: A brief literature review has enabled us to raise awareness within our department regarding this important safety concern in paediatric ophthalmic surgery, in addition to exploring management options in the case of inadvertent intravascular absorption.

Adverse Cardiovascular Effects of Phenylephrine Eye Drops Combined With Intravenous Atropine.

Background: Phenylephrine and atropine can cause serious adverse effects when applied in combination. We investigated the effect of phenylephrine eye drops combined with intravenous atropine on the cardiovascular system in patients under general anesthesia undergoing intraocular surgery. Methods: The effects of the drugs were observed through clinical study. Thirteen patients undergoing intraocular surgery under general anesthesia were observed in this study; all were injected intravenously with atropine due to the oculocardiac reflex during surgery. To study the combination of drugs, an in vivo study was performed on rats. Seventy-two standard deviation rats that received phenylephrine eye drops and intravenous atropine treatment under general anesthesia were assessed, of which 18 treated with these drugs simultaneously were administered normal saline, neostigmine or esmolol. Blood pressure and heart rate were recorded and analyzed. Findings: The age of the patients ranged from seven to 14 years old with an average age of 10.7 years old, and 11 patients were male. In patients, 5% phenylephrine eye drops combined with intravenous atropine led to a significant heart rate increase and the increase lasted 20 min. The significant increase in diastolic blood pressure and systolic blood pressure lasted for 15 and 25 min, respectively. From five to 25 min after intravenous atropine treatment, the systolic blood pressure and diastolic blood pressure were both more than 20% higher than that at baseline. In rats, the changes in blood pressure and heart rate were independent of the phenylephrine and atropine administration sequence but were related to the administration time interval. The neostigmine group showed a significant decrease in blood pressure after the increase from the administration of phenylephrine and atropine. Interpretation: Phenylephrine eye drops combined with intravenous atropine have obvious cardiovascular effects that can be reversed by neostigmine. This drug combination should be used carefully for ophthalmic surgery, especially in patients with cardio-cerebrovascular diseases.

English

BACKGROUND Dyslipidaemia has been proposed as a possible risk factor for diabetic retinopathy (DR) but results from previous studies are inconsistent. We designed this study to find the association of abnormal serum lipid levels with diabetic retinopathy and diabetic macular oedema (DME). METHODS This was a single centre observational study conducted at a tertiary care hospital, where patients with type 2 diabetes of more than five years duration were enrolled. A comprehensive ophthalmic evaluation was performed on all study subjects. Detailed fundoscopy was done after obtaining the best possible mydriasis with 1 % tropicamide and 5 % phenylephrine eye drops using direct ophthalmoscopy, indirect ophthalmoscopy with + 20 D lens and stereoscopic slit lamp biomicroscopy of the disc and macula using + 78 D Volk lens. Fundus photographs were taken in patients with any grade of diabetic retinopathy by Topcon fundus camera. DR and DME were diagnosed and classified according to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system. Fasting blood sugar (FBS), fasting lipid profile and glycated haemoglobin (HbA1c) was assessed for each patient. RESULTS A total of two hundred and twelve participants was enrolled. Mean age of the study group was 63.93 ± 9.52 and the mean duration of diabetes was 13.54 ± 6.07. DR was present in 164 (78.1 %) of whom 71 (43.3 %) had mild non proliferative diabetic retinopathy (NPDR), 42 (25.6 %) had moderate NPDR, 31 (18.9 %) had severe NPDR, and 20 (12.2 %) had proliferative diabetic retinopathy (PDR). Of those with DR, 59 (36 %) had DME. Duration of diabetes (14.62 ± 6.18 vs 9.72 ± 3.68 years, P < 0.001), higher fasting blood glucose (176.79 ± 59.13 vs 138.46 ± 49.44 mg / dL, P < 0.001), higher HbA1c (8.21 ± 1.38 vs. 7.48 ± 1.25 %, P = 0.002), higher total cholesterol (215.04 ± 49.78 vs 184.37 ± 30.84 mg / dL, P < 0.001), higher triglyceride levels (155.23 ± 59.06 vs 125.13 ± 37.3 mg / dL, P = 0.001) and higher low density lipoprotein (LDL) cholesterol levels (139.28 ± 37.38 vs 120.85 ± 22.75 mg / dL, P = 0.002) were significantly associated with the severity of DR. Higher total cholesterol, higher triglyceride levels and higher LDL cholesterol levels were also associated with DME. CONCLUSIONS There is a significant association of abnormal serum lipid levels and hyperglycaemia with the presence and severity of DR and presence of DME. Early identification and intervention to control these modifiable risk factors, hyperglycaemia and dyslipidaemia may delay the development and progression of DR in diabetic patients. These observations also support the current management strategies for diabetes, which include control of dyslipidaemia in addition to hyperglycaemia. KEYWORDS Diabetic Retinopathy, Diabetic Macular Oedema, Dyslipidaemia

Safety of tropicamide and phenylephrine in pupillary mydriasis for cataract surgery.

PURPOSE:A prospective study to evaluate the adverse cardiovascular effects of topical phenylephrine and tropicamide used for pupillary mydriasis before cataract surgery.METHODS:A total of 517 consecutive eyes in 517 patients subjected to routine 0.8% tropicamide and 5% phenylephrine eye drops before undergoing cataract surgery (phacoemulsification and manual small-incision surgery) under local or topical anesthesia in a medical college hospital were analyzed.RESULTS:No untoward cardiovascular effects were seen. The increase in blood pressure after 0.8% tropicamide and 5% phenylephrine eye drops was statistically significant, but it was not relevant as it was within clinically permissible limits.CONCLUSION:The combination of 0.8% tropicamide and 5% phenylephrine eye drops is a safe and effective option for pupillary mydriasis before cataract surgery.

Adverse Cardiovascular Effects of Phenylephrine Eye Drops Combined with Intravenous Atropine

Background: Phenylephrine and atropine can cause serious adverse effects, when applied in combination. We investigated the effect of phenylephrine eye drops combined with intravenous atropine on the cardiovascular system in patients under general anaesthesia undergoing intraocular surgery. Methods: Thirteen patients undergoing intraocular surgery under general anaesthesia were observed in this study; all were injected intravenously with atropine due to the oculocardiac reflex during surgery. Fifty-four SD rats that received phenylephrine eye drops and intravenous atropine treatment under general anaesthesia were assessed, of which 24 treated with these drugs simultaneously were administered normal saline or antagonists. Blood pressure and heart rate were recorded and analysed. Findings: In patients, topical ocular application of 5% phenylephrine and intravenous atropine treatment led to a significant heart rate increase ten minutes after intravenous atropine treatment; the increase lasted 20 minutes. The significant increase in diastolic blood pressure (DBP) and systolic blood pressure (SBP) lasted 20 and 25 minutes, respectively. From five to 25 minutes after intravenous atropine treatment, SBP and DBP were both more than 20% higher than the at baseline. In rats, the blood pressure and heart rate changes were independent of the phenylephrine and atropine administration sequence but were related to the administration time interval. The variations in blood pressure and heart rate reached their peak when phenylephrine and atropine were administered simultaneously. The urapidil and neostigmine groups showed a significant decrease in blood pressure after the increase from the administration of phenylephrine and atropine. After neostigmine treatment, the heart rate was significantly lower than that associated with normal saline treatment. Interpretation: Phenylephrine eye drops combined with intravenous atropine treatment have obvious cardiovascular effects, which can be reversed by neostigmine. These drugs combination should be used carefully for ophthalmic surgery, especially in patients with cardiocerebrovascular diseases. Funding Statement: This work was supported by the Science and Technology Program of Guangzhou of Wei Chi (No. 201804010415). Declaration of Interests: The authors have declared that no conflict of interest exists. Ethics Approval Statement: The use of experimental animals in this study complied with the animal ethics principles, and the protocol was approved by the laboratory animal ethics committee (No. 00201878).

Retinal hemorrhages in term newborns – Our experience at tertiary centre

Background: There are very few previous studies regarding ocular screening done in term neonates. Retinal hemorrhages can occur in babies during delivery. Aims: To evaluate the correlation of retinal findings with the duration of second stage of labor in term neonates and mode of delivery. Settings and Design: This was a cross-sectional, observational study done on term newborns in a tertiary care centre. Convenience sampling was done. Subjects and Methods: Neonates were examined in the postnatal ward using handheld slit lamp and indirect ophthalmoscope. Fundus examination was done after dilating the pupils with 0.5% tropicamide and 2.5% phenylephrine eyedrops. Second stage of labor and mode of delivery were noted. Chi-square test and independent sample t-test were used to analyze the data. Results: One hundred and fifty infants were screened, of which 75 (50%) had retinal hemorrhages. Chi-square test showed statistical significance with duration of second stage of labor and occurrence of retinal hemorrhages (P < 0.001). Patients with second stage of labor shorter than 30 minutes of duration were found to have more chances of having retinal hemorrhages. Independent sample t-test used for association between mode of delivery and retinal hemorrhages showed patients born of normal vaginal delivery to have more chances of having hemorrhages (P = 0.006). Chi-square test showed statistical significant association with the presence of hemorrhages and day of evaluation (P < 0.001). Conclusion: Retinal hemorrhages were found to be common in full-term babies whose second stage of delivery was shorter than 30 minutes of duration.

Subarachnoid hemorrhage in a patient following systemic absorption of phenylephrine eye drops.

Subarachnoid hemorrhage in a patient following systemic absorption of phenylephrine eye drops.

Relationship between the phenylephrine test and eyelid droop after aponeurotic repair with the use of an epinephrine-containing local anaesthetic.

PurposeTo analyse the relationship between the results of the phenylephrine test and postoperative eyelid droop in transcutaneous aponeurotic repair using epinephrine-containing local anaesthetic for aponeurotic blepharoptosis.Patients and methodsWe retrospectively reviewed the medical records of 66 eyelids from 40 patients who underwent transcutaneous aponeurotic repair. A positive phenylephrine test result was defined as an increase in margin reflex distance-1 (MRD-1) ≥0.5 mm after application of phenylephrine eye drops. The patients were divided into a positive phenylephrine response group (Group A, 16 patients) and a negative phenylephrine response group (Group B, 24 patients). The ΔMRD-1 was calculated by subtracting the 3-month postoperative value from the intraoperative value. Patient age, sex, pre- and intraoperative MRD-1s, levator function, and phenylephrine response were investigated as factors potentially influencing the ΔMRD-1. The relationship between these factors and ΔMRD-1 was analysed using single and multiple regression analysis.ResultsThe ΔMRD-1 in Group A (0.68±0.52 mm) was significantly greater than that in Group B (0.17±0.56 mm; P=0.004). A moderate correlation was found between phenylephrine response and ΔMRD-1 in the total patient group (YΔMRD-1=0.441 Xphenylephrine+0.358; r=0.462; r2=0.213; P=0.002).ConclusionsAlthough the ΔMRD-1 in Group B was quite small, the ΔMRD-1 in Group A was considerable, and there was a moderate positive correlation between phenylephrine response and the ΔMRD-1 overall. This indicates that the degree of postoperative eyelid droop can be estimated by the phenylephrine test results in transcutaneous aponeurotic repair.

Allergic contact dermatitis from phenylephrine eye drops

Allergic contact dermatitis from phenylephrine eye drops

瞳神紧小方治疗前葡萄膜炎风湿夹热型的临床观察

目的：观察瞳神紧小方对风湿夹热型急性前葡萄膜炎患者临床疗效。方法：将诊断为风湿夹热型急性前葡萄膜炎患者60例，随机分为对照组和治疗组，治疗组予瞳神紧小方、美多丽和典必殊治疗，对照组仅予美多丽和典必殊治疗。随访观察2周，比较2组疗效。结果：1) 视力疗效：治疗一周、二周，治疗组视力有效率分别为86.67%、96.6%，对照组视力有效率分别为60%、83%。治疗一周、二周后组间差异有统计学意义(P Objective: To observe the clinical effect of Tongshenjinxiao prescription for acute anterior uveitis with syndrome of wind heat dampness. Methods: Sixty patients (60 eyes) of acute anterior uveitis with syndrome of wind heat dampness were randomly divided into control group and treatment group as research object according to the diagnostic criteria. The treatment group was treated with Tongshenjinxiao prescription, tropicamide phenylephrine eye drops and tobradex eye drops. The control group was treated with tropicamide phenylephrine eye drops and tobradex eye drops. Follow up observation lasted for 2 weeks, the effects of the 2 groups were compared. Result: 1) The curative effect of vision: After 1 week and 2 weeks, the vision efficiency of the treatment group was 60% and 83% respectively while the counterpart of control group was 60% and 83%. 1 week and 2 weeks after treatment, the difference between groups was statistically significant (P < 0.05). 2) Anterior segment sign: 1 week and 2 weeks after treatment, the treatment group was superior to the control group in improving the ciliary congestion, posterior corneal sediment, aqueous humor and planktonic cell signs. The difference between groups was statistically significant (P < 0.05). 3) The curative effect of TCM syndrome: after 1 week, 2 weeks, the total effective rate of the treatment group was 93.33% and 93.33% respectively while the results of control group was 63.33% and 73.33%. At each time point, the curative effect in treatment group was better than that in control group (P < 0.05). Conclusion: Tongshenjinxiao prescription was used to treat acute anterior uveitis with syndrome of wind heat dampness. It could significantly improve the anterior segment signs, visual acuity and relieve symptoms of wind heat dampness.

Allergic contact conjunctivitis and cross-reaction between phenylephrine and epinephrine due to phenylephrine eye drops

Allergic contact conjunctivitis and cross-reaction between phenylephrine and epinephrine due to phenylephrine eye drops

Pattern of Change in Accommodation and its Correlation with Mydriasis in Young Emmetropes After Instillation of Tropicamide Phenylephrine Eye Drops

Cycloplegics relax accommodation by blocking the action of ciliary muscles. The mydriasis obtained with these drugs is expected to be related to the degree of cycloplegia. This study evaluates the change in accommodation in young emmetropes and its correlation with mydriasis post instillation of tropicamide phenylephrine eye drops. A prospective descriptive study. Young adults of age group 18-22 years with uncorrected visual acuity of 6/6, near vision N6 and no asthenopic symptoms were included in the study. Age of the subject, NPA (near point of accommodation), NPC (near point of convergence), AA (accomodation amplitude), objective refraction with Autorefractometer, pupillary size and near vision (NV) were noted. The study group included 25 cases; mean age of 20.54 years (SD 1.046years). The amount of accommodation relaxed by drug ranged from 2.75D to 4.50 D. NPA, NPC, AA were inversely proportional to accommodation relaxed (p=0.00). The rate of change of pupillary dilatation and cycloplegia differed. The cycloplegic effect had a positive correlation with the increase in the visual angle; but was independent of the mydriatic effect.

Combination of 5% phenylephrine and 0.5% tropicamide eyedrops for pupil dilation in neonates is twice as effective as 0.5% tropicamide eyedrops alone.

Comparison of the efficacy of tropicamide eyedrops to the combination of 0.5% tropicamide and 5% phenylephrine eyedrops in order to achieve a proper dilation in premature infants undergoing screening for retinopathy of prematurity. A prospective, randomized, double-blind study was conducted to compare the efficacy of two mydriatic regimens: one regimen consisting of three drops of 0.5% tropicamide (TTT regimen), the other regimen consisting of one drop of 5% phenylephrine and two drops of 0.5% tropicamide (PTT regimen). Thirty premature infants were enrolled and received both mydriatic regimens: one regimen in each eye. Outcomes were pupil dilation evaluated by the percentage of pupil diameter over cornea diameter, the percentage of pupil surface over cornea surface and the quality of the eye fundus examination. The percentage of pupil diameter over cornea diameter was 47.3% (±8.7) with the TTT regimen and 65.9% (±8.8) with the PTT regimen (p<0.0001). The percentage of pupil surface over cornea surface was 23.1% (±8.3) with the TTT regimen and 43.8% (±7.3) with the PTT regimen (p<0.0001). Thus, the pupil surface area was 1.9 times greater with the PTT than with the TTT regimen. Visualization of the retinal periphery was possible for 30 of 30 eyes dilated with the PTT regimen and for 16 of 30 eyes dilated with the TTT regimen (p<0.0001). The dilated pupil surface area for the combination of 5% phenylephrine and 0.5% tropicamide was almost twice that for 0.5% tropicamide eyedrops alone and provided significantly superior quality of the eye fundus examination.

Ophthalmic insert for pupillary mydriasis in neonates

PurposeTo study efficacy and tolerance of ophthalmic insert Mydriasert® versus standard treatment phenylephrine and tropicamide eye drops for fundus examination in neonates.MethodsProspective, randomised, single‐blinded non‐inferiority study of 80 premature and full‐term babies and infants treated for fundus examination. Mydriasis was obtained with two groups randomly assigned. The eye drop group received three instillations of 2.5% phenylephrine and 0.5% tropicamide and the insert group received Mydriasert® containing phenylephrine and tropicamide. The mydriasis was evaluated 75 minutes after the introduction of the mydriatic agents.ResultsThe mydriasis was successfully achieved in both eyes in 97.5% of infants in the insert group and 90% in the eye drop group at 75 minutes after dispensation. The efficacy of the insert was non‐inferior compared to the eye drops. To reach effective mydriasis, the insert group required fewer nursing interventions for one patient comparing to the eye drop group. Good general and local tolerance was observed in the two groups. However two patients reported an adverse event as bradycardia and gastro‐oesophageal reflux that could be related to neonate pathology.ConclusionsMydriasis obtained with the ophthalmic insert Mydriasert® was not inferior compared to standard eye drop treatment. Insert reduced the number of nursing interventions to obtain mydriasis for a fundus examination.