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Mydriatic
Aka: Mydriatic, Cycloplegic, Eye Dilating Drop, Tropicamide, Mydriacyl, Ak-Dilate, Mydfrin, Cyclopentolate, Cyclogyl, Homatropine hydrobromide, Atropisol, Atropine-care, Isopto Atropine, Isopto Hyoscine
- Definition
- Topical medications that cause Pupil Dilation (Mydriasis)
- Mechanism
- Agents based on Atropine which blocks muscarinic acetylcholine receptors
- Blocks pupillary constriction
- Indications
- Retinal Exam
- Eye Pain (prevents ciliary muscle spasm)
- Contraindications
- Narrow Angle Glaucoma
- Following pupillary signs after Head Injury
- Iris supported intraocular lens implantation (square/hexagonal pupil 'sputnik')
- 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]
- 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
- 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
- References
- Fishbaugh (1994) J Am Soc Ophth Reg Nurs 19(1):30-2
- http://ir.uiowa.edu/cgi/viewcontent.cgi?article=1003&context=eye_pubs