II. Definition
- Topical Medications that cause Pupil Dilation (Mydriasis)
III. Mechanism
- Agents based on Atropine which blocks Muscarinic Acetylcholine Receptors
- Blocks pupillary constriction
IV. Indications
- Retinal Exam
- Eye Pain (prevents ciliary Muscle spasm)
V. Contraindications
- Narrow Angle Glaucoma
- Following pupillary signs after Head Injury
- Iris supported intraocular lens implantation (square/hexagonal pupil 'sputnik')
VI. Adverse Effects
-
Narrow Angle Glaucoma
- Precipitating Narrow Angle Glaucoma is rare with Mydriatics used for diagnostic exam
- Wolfs (1997) Invest Ophthalmol Vis Sci 38(12): 268307 +PMID:9375589 [PubMed]
VII. Preparations: Eye Dilation for Retinal Exam (rapid onset, shorter duration preferred)
- Tropicamide 0.5% - 1% (Mydriacyl)
- Onset: 20-40 minutes
- Duration: 4-8 hours in most cases (may last as long as 24 hours)
- Blue eyes more sensitive, lasts longer
- Start with 0.5% concentration
-
Phenylephrine hydrochloride 2.5% (Ak-Dilate, Mydfrin)
- Onset: 30-60 minutes
- Duration: 3-5 hours
- Unlike other agents, results in Mydriasis, but no cycloplegia
- Risk of Chemical Eye Injury
VIII. Preparations: Eye Pain management to reduce ciliary spasm (longer duration preferred)
- Cyclopentolate 0.5 to 2% (Cyclogyl)
- Typically use 1% in adults and 0.5% in children
- Rapid onset with peak activity at 25-75 min
- Duration: 6 to 24 hours (mean 12 hours); up to 2 days in some cases
-
Scopolamine 0.25% (Isopto Hyoscine)
- Onset 30-60 minutes
- Duration 4-7 days
- Homatropine hydrobromide 2%
- Onset: 30-60 minutes
- Duration: 3 days
- Avoid in children
-
Atropine sulfate (Atropisol, Atropine-care, Isopto Atropine)
- Onset: 45-120 minutes
- Duration: Up to 1-2 weeks
IX. References
- Fishbaugh (1994) J Am Soc Ophth Reg Nurs 19(1):30-2
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Related Studies
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 |
Ontology: Cycloplegics (C0010586)
Concepts | Pharmacologic Substance (T121) |
MSH | D009184 |
SnomedCT | 412172009 |
French | Agents cycloplégiques, Médicaments cycloplégiques, Cycloplégiques |
Portuguese | Cicloplégicos |
Spanish | Cicloplegicos, ciclopéjico, preparación ciclopéjica (producto), ciclopéjico (producto), preparación ciclopéjica |
German | Zycloplegika |
English | cycloplegics, cycloplegic, Cycloplegic preparation (product), Cycloplegic preparation, Cycloplegics |
Czech | cykloplegika |
Italian | Cicloplegici |
Ontology: Mydriatics (C0026964)
Definition (MSH) | Agents that dilate the pupil. They may be either sympathomimetics or parasympatholytics. |
Concepts | Pharmacologic Substance (T121) |
MSH | D009184 |
SnomedCT | 33682005, 372710003 |
English | Mydriatics, mydriatics (medication), ophthalmologicals mydriatics, mydriatics, mydriatic, Mydriatic (product), Mydriatic (substance), Mydriatic, Mydriatic, NOS |
French | Agents mydriatiques, Médicaments mydriatiques, Mydriatiques |
Swedish | Pupillvidgande medel |
Czech | mydriatika |
Finnish | Mydriaatit |
Russian | MIDRIATIKI, TSIKLOPLEGICHESKIE SREDSTVA, MIDRIATICHESKIE SREDSTVA, МИДРИАТИКИ, МИДРИАТИЧЕСКИЕ СРЕДСТВА, ЦИКЛОПЛЕГИЧЕСКИЕ СРЕДСТВА |
Croatian | MIDRIJATICI |
Polish | Mydriatica, Leki rozszerzające źrenice, Środki cykloplegiczne |
Spanish | Efecto Midriático, midriático (producto), midriático (sustancia), midriático, Midriáticos |
Portuguese | Efeito Midriático, Midriáticos |
German | Mydriatika |
Italian | Midriatici |