Cycloplegic agent

As mydriatic and cycloplegic agent Atropine is used to produce mydriasis and cycloplegia for testing errors of refraction. Mydriasis is required for fundoscopic examination and in the treatment of iritis and keratitis. 

Accommodative amplitude measurements after instillation of 2.5% or 10% phenylephrine generally indicate that the effect is far less than the decrease observed with cycloplegic agents such as tropicamide (see Chapter 9). A loss of approximately 2.00 D (7.93 D from 9.95 D) at... 

Modified from Milder B. Tropicamide as a cycloplegic agent. Arch Ophthalmol 1961 66 60. Copyright 1961, American Medical Association. 

The advantage of tropicamide compared with other mydriatic-cycloplegic agents is its fast onset and relatively short duration of action. Practitioners shonld note that, clinically, tropicamide has a greater mydriatic than cycloplegic effect. Although tropicamide is not the dmg... 

Manny RE, Hussein M, Scheiman M, et al.Tropicamide (1%) an effective cycloplegic agent for myopic children. Invest OphthalmolVis Sci 2001 42 1728-1735. 

This chapter considers the indications, precautions, and contraindications associated with the use of cyclo-plegics in refraction.The chapter also discusses such clinical topics as selecting the appropriate cycloplegic agent, administration techniques, procedures for refraction, and general considerations for spectacle prescribing. 

Caution must be exercised when using cycloplegic agents in infants, because they are more susceptible to systemic complications due to their immature metabolism and excretion systems and their low body weight. The clinician should use the lowest concentration of drug that yields the desired cycfoplegia. 

Generally, when selecting cycloplegic agents for use in infants (12 months of age and younger), in patients with Down syndrome, and in patients with other central nervous system disorders, the lowest concentration of the appropriate drug is recommended. More specifically, when using tropicamide and/or cyclopentolate,the 0.5% concentration should be used rather than the 1% concentration for these patient populations. 

Cycloplegic Agent Commonly Used Concentration (%) Onset of Maximum Cycloplegic Effect Duration of Cycloplegic Effect Relative Residual Accommodation... 

Management of the ocular aspects of Reiter s syndrome is directed toward control of inflammation.The uveitis can be fairly severe and resistant to therapy. In most instances such topical steroids as 1% prednisolone acetate or 0.1% dexamethasone are recommended. Dosage is variable but in severe cases should be administered initially every 1 to 2 hours and accompanied by such cycloplegic agents as 5% homatropine or 0.25% scopolamine two to three times daily. Aggressive treatment reduces formation of synechiae and subsequent secondary glaucoma. In patients who have severe uveitis, either sub-Tenon s capsule or oral steroids may be used in conjimction with topical management. 

Some practitioners prefer not to recommend the use of therapeutic soft contact lenses during episodes of bullae eruption. When a patient presents with corneal epithelial defects due to ruptured bullae, a prophylactic antibiotic ointment such as 0.3% tobramycin or 0.3% ciprofloxacin four times a day can be administered, along with a cycloplegic agent (e.g., 5% homatropine two times a day). 

During acute episodes a broad-spectrum topical prophylactic antibiotic ointment, such as 0.3% tobramycin or 0.5% moxifloxacin, protects the cornea from secondary infection while it heals. The use of a therapeutic contact lens and topical NSAIDs, such as diclofenac sodium 0.1% solution or ketorolac 0.5% solution, provide symptomatic relief. The therapeutic soft contact lens also protects the regenerating epithelium and temporarily provides epithelial stability. A cycloplegic agent, such as 5% homatropine, should be instilled to decrease ciliary spasm and pain. Oral analgesics can be prescribed as needed (see Chapter 7). The eye should be examined in 24 hours and the therapy continued until the epithelial defect is healed. 

Cycloplegic agents, such as 5% homatropine instilled three times a day or 1% atropine two times a day, may help decrease the iritis associated with infectious keratitis and decrease patient discomfort. 

If there is an anterior chamber reaction or if debridement has been performed, a cycloplegic agent such as 5% homatropine or 0.25% scopolamine should be used two to three times a day. Topical steroids should be tapered or discontinued in any patient using them, because they are contraindicated in the presence of active HSV corneal epithelial disease. Antibiotics have no benefit in the treatment of herpes simplex epithelial disease but can be used prophylactically if the epithelial defect is greater than 6 mm in size. 

Unlike dendritic keratitis, indolent ulcers are typically very difficult to treat. Instillation of a prophylactic antibiotic, such as polymyxin B-bacitracin ointment two to four times a day, and a cycloplegic agent, such as 5% homatropine two to three times a day, is indicated. Therapeutic soft contact lens use with appropriate antibiotic therapy can also be considered as alternatives. These patients must be monitored carefully to ensure that no secondary infection develops. If the ulcer deepens, a new infiltrate forms, or if there is an increase in the anterior chamber reaction while the patient is being treated, cultures should be performed to rule out bacterial or fungal infection. Cyanoacrylate glue, conjunctival flap surgery, or tarsorrhaphy may be required if healing does not occur. 

Like corticosteroids, cycloplegic agents are selected and dosed according to the severity of the inflammation. Five percent homatropine two to three times a day may... 

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