23 Cycloplegics

Question 1

Indications for cyclo

Answer 1

Strab, accom esoT

Children under 3

Pseudomyopia

High phorias

Question 2

What should you do before cyclo

Answer 2

History
- sensitive to drug, general health and fam hx glaucoma

Slit lamp Vh

Refraction as phorias meaningless after cyclo

Tono

Question 3

Commonly used cycloplegia

Answer 3

Cyclo 0.5%/1%

Tropicamide 1%

Atropine sulphate 1%

Hyoscine 0.1-0.25%

Homatropine 2-5%

Question 4

Cyclopentolate percent use in kids, onset, max response and recovery

Answer 4

1% if <16 but 0.5 if older

Onset minutes

Max 30min

Recovery up to 24 hrs cycloplegia and several days for mydriasis

Question 5

How to change instillation of cyclo so it’s more effective on dark irides

Answer 5

Cyclopentolate 1% with tropicamide 1%

OR

Proparacaine 0.5% before cyclopentolate

Question 6

Onset and recovery for tropicamide as a cycloplegia

Answer 6

Onset in minutes

Refraction can be done in 30min or 45min for dark irides

Recovery for cyclo within 3hrs and mydriasis is 6-8hrs

Question 7

How to use atropine sulphate 1%

Answer 7

Put in 3 days prior

Onset and recovery is iris pigment dependent

Mydriasis recovery 2wks

Cyclo recovery is 10-18days

Question 8

Tonus allowance for atropine sulphate 1%

Over +4.5

+0.5-4.5

Answer 8

Over 4.5 is allowing 1 D

Next allow 0.5D

No allowance

Question 9

Toxicity reactions to cycloplegia drugs

Answer 9

Same as before but also

Bowel and bladder lose their tone

Heart runs alone

Question 10

Toxic reactions or cyclopentolate

Answer 10

Stings in instillation, lacrimaTION

early signs of toxicity 
- drowsiness
Restlessness
Emotional disturbance
Ataxia