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

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

VIII. Preparations: Eye Pain management to reduce ciliary spasm (longer duration preferred)

  1. Cyclopentolate 0.5 to 2% (Cyclogyl)
    1. Rapid onset with peak activity at 25-75 min
    2. 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
    1. Onset: 30-60 minutes
    2. Duration: 3 days
  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 3/22/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
TROPICAMIDE 1% EYE DROPS Generic $0.36 per ml
cyclopentolate (on 9/21/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
CYCLOPENTOLATE 1% EYE DROPS Generic $4.49 per ml
CYCLOPENTOLATE HCL 2% DROPS Generic $10.30 per ml

Ontology: Cycloplegics (C0010586)

Concepts Pharmacologic Substance (T121)
MSH D009184
SnomedCT 412172009
French Agents cycloplégiques, Médicaments cycloplégiques, Cycloplégiques
Portuguese Cicloplégicos
Spanish Cicloplegicos, ciclopéjico, preparación ciclopéjica (producto), ciclopéjico (producto), preparación ciclopéjica
German Zycloplegika
English cycloplegics, cycloplegic, Cycloplegic preparation (product), Cycloplegic preparation, Cycloplegics
Czech cykloplegika
Italian Cicloplegici

Ontology: Mydriatics (C0026964)

Definition (MSH) Agents that dilate the pupil. They may be either sympathomimetics or parasympatholytics.
Concepts Pharmacologic Substance (T121)
MSH D009184
SnomedCT 33682005, 372710003
English Mydriatics, mydriatics (medication), ophthalmologicals mydriatics, mydriatics, mydriatic, Mydriatic (product), Mydriatic (substance), Mydriatic, Mydriatic, NOS
French Agents mydriatiques, Médicaments mydriatiques, Mydriatiques
Swedish Pupillvidgande medel
Czech mydriatika
Finnish Mydriaatit
Russian MIDRIATIKI, TSIKLOPLEGICHESKIE SREDSTVA, MIDRIATICHESKIE SREDSTVA, МИДРИАТИКИ, МИДРИАТИЧЕСКИЕ СРЕДСТВА, ЦИКЛОПЛЕГИЧЕСКИЕ СРЕДСТВА
Croatian MIDRIJATICI
Polish Mydriatica, Leki rozszerzające źrenice, Środki cykloplegiczne
Spanish Efecto Midriático, midriático (producto), midriático (sustancia), midriático, Midriáticos
Portuguese Efeito Midriático, Midriáticos
German Mydriatika
Italian Midriatici