II. Definition

III. Mechanism

  1. Agents based on Atropine which blocks Muscarinic Acetylcholine Receptors
  2. Blocks pupillary constriction

IV. Indications

  1. Retinal Exam
  2. Eye Pain (prevents ciliary Muscle spasm)

V. Contraindications

  1. Narrow Angle Glaucoma
  2. Following pupillary signs after Head Injury
  3. Iris supported intraocular lens implantation (square/hexagonal pupil 'sputnik')

VI. Adverse Effects

VII. Preparations: Eye Dilation for Retinal Exam (rapid onset, shorter duration preferred)

  1. Tropicamide 0.5% - 1% (Mydriacyl)
    1. Onset: 20-40 minutes
    2. Duration: 4-8 hours in most cases (may last as long as 24 hours)
    3. Blue eyes more sensitive, lasts longer
    4. Start with 0.5% concentration
  2. Phenylephrine hydrochloride 2.5% (Ak-Dilate, Mydfrin)
    1. Onset: 30-60 minutes
    2. Duration: 3-5 hours
    3. Unlike other agents, results in Mydriasis, but no cycloplegia
    4. Risk of Chemical Eye Injury

VIII. Preparations: Eye Pain management to reduce ciliary spasm (longer duration preferred)

  1. Cyclopentolate 0.5 to 2% (Cyclogyl)
    1. Typically use 1% in adults and 0.5% in children
    2. Rapid onset with peak activity at 25-75 min
    3. Duration: 6 to 24 hours (mean 12 hours); up to 2 days in some cases
  2. Scopolamine 0.25% (Isopto Hyoscine)
    1. Onset 30-60 minutes
    2. Duration 4-7 days
  3. Homatropine hydrobromide 2%
    1. Onset: 30-60 minutes
    2. Duration: 3 days
    3. Avoid in children
  4. Atropine sulfate (Atropisol, Atropine-care, Isopto Atropine)
    1. Onset: 45-120 minutes
    2. Duration: Up to 1-2 weeks

IX. References

  1. Fishbaugh (1994) J Am Soc Ophth Reg Nurs 19(1):30-2
    1. http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1003&context=eye_pubs

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Related Studies

Cost: Medications

tropicamide (on 5/18/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TROPICAMIDE 1% EYE DROP Generic $0.43 per ml
TROPICAMIDE 1% EYE DROPS Generic $0.43 per ml
cyclopentolate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CYCLOPENTOLATE 1% EYE DROP Generic $1.15 per ml
CYCLOPENTOLATE 1% EYE DROPS Generic $3.31 per ml
isopto atropine (on 8/17/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ISOPTO ATROPINE 1% EYE DROP $9.70 per ml