Mydriatic

Aka: Mydriatic, Cycloplegic, Eye Dilating Drop, Tropicamide, Mydriacyl, Ak-Dilate, Mydfrin, Cyclopentolate, Cyclogyl, Homatropine hydrobromide, Atropisol, Atropine-care, Isopto Atropine, Isopto Hyoscine

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II. Definition

  1. Topical Medications that cause Pupil Dilation (Mydriasis)

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

  1. Narrow Angle Glaucoma
    1. Precipitating Narrow Angle Glaucoma is rare with Mydriatics used for diagnostic exam
    2. Wolfs (1997) Invest Ophthalmol Vis Sci 38(12): 268307 +PMID:9375589 [PubMed]

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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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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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