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OV3017 Eye Disease > 6 - Cycloplegics > Flashcards

6 - Cycloplegics Flashcards

1
Q

why do we use cycloplegics

A
  1. assessment of refrative error

latent hyperopia

  1. penalisation
  2. adaptation to specs
  3. anterior uveitis - dilating pupil + alleviating ciliary spasm
  4. corneal abrasion ^
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2
Q

what are the optometric indications from history &symptoms

A
  • asthenopia
  • reading difficulties
  • manifest deviation
  • FH of refractive error at early age
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3
Q

what are the optometric indications from clinical tests

A

** bv anomaly**
* manifest eso
* sometiems latent deviation

** fluctuating ret pic**
- large diff beween subjective and objective
- poor fixation

VA reduced

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4
Q

what are the ideal properties of a cycloplegic

A
  • rapid onset
  • adequate depth + duration
  • no stinging
  • no mydriasis
  • no toxic effects
  • local
  • systemic
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5
Q

what are the effects of cycloplegics

A
  1. initilally mydriasis
    - as iris located anteriorly to ciliary muscle (unnecessary side effect)
  2. cycloplegia
    - paralysis of the ciliary muscle, resulting in loss of accommodation. due to paralysis, curvture of lens can no longer be adjusted to focus on near
  3. reduced tear secretion
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6
Q

what do anti muscarinic agents affect

A
  • lacrimal gland
  • iris sphincter muscle
  • ciliary body
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7
Q

what advice should you give before instillation

A

explain need ot use, onset, duration, expected side effects, caution

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8
Q

if consent is denied?

A

parent
- explain adv and disadv
- note refusal on record
- if concern for child great, refer to GP

child
- gillick competent: can child agree themselves
- record all discussions

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9
Q

checking for cycloplegia

A
  • measure accommodaton
  • check ret reflex
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10
Q

does mydriasis indicate that cycloplegia has been achieved

A

no

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11
Q

Cycloplegic ret

A
  • sit child on parent knee
  • ask px to fixate upon light
  • no need to fog other eye
  • observe central movement, ignore periphery

abberations higher due to larger pupil

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12
Q

tropicamide is the weakest or stongest?

A

weakest. only effective in adults

1%, used as mydriatic

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13
Q

most commonly used cycloplegic

A

cyclopentolate 0.5% and 1%

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14
Q

what is atropine sulphate

A
  • toxic agent
  • POM
  • used by IP
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15
Q

what are the preparations of atropine

A
  • AS eye drops 0.5% and 1%
  • AS eye ointment; 1%
  • minims: 1% (bausch&lomb)

store below 25 and protect from light

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16
Q

what are the doses for atropine in adults and children >3months

A

1) eye drops
- one drop (1%) twice per day for 1-3 days before refraction

2) ointment
- two times a day 1-3 days before refraction

17
Q

atropine- timing

A
17
Q

what is the atropine tonus allowance

A
  • allowance needs to be made for dependant tone
  • spherical adjusted in LESS positive direction
  • -1.00DS for low myopes annd hyperopes
  • 0.00DS for moderate and high myopes
18
Q

what are the contraindications of atropine

A
  • known allergies
  • narrow angles
19
Q

cautions of atropine

A
  • children <3 months
  • elderly/ill
  • down syndrome
  • children with brain damage
  • soft cl
  • hyper sensitvity
    -intermittent manifest deviations
20
Q

atropine sulphate ocular side effects

A
  • transient stinging
  • blurring
  • photophobia
  • raised IOP

after repeated use
- hyperaemia
- oedema
- itching/irritation
- follicular conjunctivitis

21
Q

atrophine suulphate general body side effects

A
  • dry mouth/skin
  • flushing/increased body temp
  • cyclopegia
  • ataxia, hallucinations, confusion, difficulty speaking
  • tachycarida

death from respiratory depression (more likely in kids)

dry as a bone, red as a beetroot, blind as a bat, mad as a hatter

22
Q

what are the additinal uses of atropine

A

to treat amblyopia
- instilled into better eye
- prevents accommodation
- used when child will not tolerate patching
- excellent resulys

23
Q

cyclopentolate hcl

A
  • commonly used cycloplegic
  • synthetic drug
24
Q

cyclopentolate preparations

A

POM for optoms

mydrilate: eye drops
- mydrilate
- 0.5% cyclopentolate HCL
- 1.0% cyclopentolate HCL
stored between 2-8

minims
- 0.5%
1%

store below 25, protect from light

25
Q

timings of cyclopentolate?

A
  • commences after few min( max 30-60)
  • recovery is 4-12 hrs

-mydriasis - 30 mins
- recovery 24-48

residual accom <1.50D

26
Q

cyclopentolate tonus allowance?

A
  • none
    -give full rx

exceptions
- hyperopia and exo deviation
- myopia and eso deviation

27
Q

cyclopentolate cautions

A
  • young children
    -ill
  • elderly
  • avoid over dosage in dark eyes
  • compressing lacrimal sac
  • pregnancy + lactation
  • hallucinations reported
28
Q

ocular side effects of cyclopentolate

A
  • transient stinging/blurring
  • photophobia
  • rasied IOP
  • conjunctival hyperaemia and oaedma

after prolonged administration
- irrtitation
- hyperaemia
- oaedema
- conjunctivitis

29
Q

general body side effects of cyclopentolate

A
  • dose related -children
  • cns effects
    -dry mouth
  • flushing
    -tachycardia
  • urinary symptoms
    -GI symptoms
30
Q

what are additonal uses of cyclopentolate

A
  • adaptation to specs
  • use 1% cyclo daily for 2 weeks
  • accom abolished
  • clear vision obtained by spec wear
  • child then accepts spec wear
31
Q

what disease is cyclo useful for

A
  1. anterior + posteripr uveitis and posterior synechiae breakdown:
    - 1-2 drops instilled every 8 hours
  2. alleviation of ciliary spasm
    - 1 drop 2-3 times a day
32
Q

what is homatropine hydrobromide

A

POM
1% multi dose containers
store below 25
protect from light

33
Q

what is homatropine hydrobromide used for

A
  • dilating pupils in anterior uveitis
  • alleviation of ciliary spasm following corneal abrasion
34
Q

tropicamide inidcated for cycloplegia in?

A

adults

35
Q

when is atropine used?

A

when 1% cyclopentolate doesnt produce adequate cycloplegia

OV3017 Eye Disease (19 decks)

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