Cycloplegic agent atropine

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. 

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. 

It was soon found that any simplification of atropine s esterifying acid (tropic acid) (7.77) diminished the activity. By changing this to mandelic acid (7.75), a cycloplegic agent (homatropine) was obtained with a shorter, more... 

Among the cycloplegics most frequently used are cycfopentolate and atropine. Because of their potential side effects, a careful history and assessment of the anterior chamber angle are necessary before use. Selection of the appropriate agent is also important (see Chapter 21). If there is a risk of angle closme, this risk must be communicated to patients, and informed consent should be obtained before the drug is administered. 

In low dosages scopolamine can produce effects on the CNS, presmnably due to its ability to penetrate the blood-brain barrier. Drowsiness and confusion are frequently reported. Patients also tend to exhibit a higher incidence of idiosyncratic reactions to scopolamine than to other anticholinergic agents, and, hence, it is not the drug of first choice for cycloplegic refraction or treatment of anterior uveal inflammations. Its use is reserved primarily fiar patients who exhibit sensitivity to atropine. 

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