Mydriatics and Cycloplegics

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Precautions:-

Mydriatics and cycloplegics should be used with some care when patients exhibit narrow angles. Complications can occur, but are not common, and can be dealt with should an emergency occur. Side effects will be blurred vision and photobia, and driving immediately after dilation or cycloplegia is not recommended.

Intra-ocular lenses :-

It is generally considered safe to dilate patients with posterior chamber extra-capsular lenses, but mydriatics are contra-indicated in patients with iris clip intra-ocular lenses, anterior chamber lenses, and dislocated lenses, (natural or implanted).

Treatment of iatrogenic angle closure glaucoma:-

Oral acetazolamide as Diamox is generally considered the best adjunct to counteracting acute angle closure glaucoma. Topical carbonic anhydrase inhibitors such as Trusopt may also prove useful.

In reality pilocarpine is the most likely drug to be used in optometric practice. If the pupil fails to respond to repeated doses of pilocarpine eyedrops, physostigmine should produce a stronger effect. In a hospital setting, even stronger miotics such as echothiophate are used. In general, the dosage of the miotic chosen should be commensurate with the severity of the condition. For example 2% pilocarpine might be used to counteract tropicamide, and 4% to counteract cyclopentolate.

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