Cycloplegics Flashcards
What are the optometric uses of cycloplegics?
-Assessment of rx for latent hyperopes
-Penalisation to occlude an eye
-Spectacle adaptation (rare)
What are ophthalmological uses of cylcoplegics?
-Anterior uveitis to dilate the pupil and alleviate a ciliary spasm
-Corneal abrasions to alleviates ciliary spasm
Name seven indications to using cycloplegics
1) Symptoms such as reading difficulties, asthenopia
2) History of manifest deviations
3) FH
4) BV anomaly
5) Fluctuating ret (poor fixation)
6) Accommodative anomalies
7) VA reduced
What is an unnecessary side effect of cycloplegics?
Mydriasis- dilated pupils
What causes the loss of accommodation with cycloplegics?
Paralysis of the ciliary muscles, lenses can no longer change shape
What three parts of the eye do cycloplegics effect?
1) Lacrimal gland
2) Iris sphincter muscle
3) Ciliary body
What advice should you give to the px/ their guardians
-Why you are using it/ how it is going to benefit the px
-Onset
-Duration
-Expected side effects -temporary blurred vision
-Caution
- One drop in each eye
What should you do if consent is denied?
Re-explain advantages and disadvantages, note refusal and get px to sign to, if concern for child then refer to GP, Gillick competent (can the child agree for themselves), record discussions on notes
How should you instil the drops and how should your check for cycloplegia?
Drop on to eye lashes and measure accommodation with RAF rule or ret flex
*MYDRIASIS DOES NOT EQUAL CYCLOPLEGIA
Name four cycloplegics
1) Atropine 1% strongest cycloplegic
2) Cyclopentolate (0.5% and 1%)
3) Homatropine (1%)
4) Tropicamide (1%) weak cycloplegic
What are different tubes/storages that atropine comes in?
- Eye drops (0.5% or 1%)
- Eye ointments (1%)
- Minims (1%)
STORE BELOW 25 degree
How times/ drops of atropine should be installed and when?
1 drop twice a day about one to three days before a refraction
How times a day should ointment atropine be installed and when?
Twice a day, for 1-3 days before the refraction- it is preferable as it reduces systematic toxic effects
With atropine, what allowance needs to be made for dependent tone?
-1.00DS for low myopic and hyperopes
0.00DS for moderate-high myopes
*ONLY FOR ATROPINE
What are some contraindications to using atropine ?
Known allergy, narrow angles
What are some cautions to using atropine ?
Children < 3 months, elderly, Down’s syndrome, brain damage children, soft CLs wearers, intermittent manifest deviations, pregnant, any known interactions
What are the side effects of atropine sulphate?
- Stinging
- Photophobia
- Raised IOPs
- Blurring
- Repeated use= hyperamia, oedema, itching, follicular conjunctivitis
What are toxic side effects of atropine on the general body?
Dry mouth, flushing, cycloplegia, ataxia, confusion, increased body temp, tachycardia, death from respiratory depression, hallucinations
In what circumstance would atropine be used for patching/penalisation?
If they do not tolerate patching, it is instilled into the better eye and used to treat amblyopia by preventing accommodation
What forms does cyclopentolate hydrochloride come in?
Mydrilate eye drops (0.5% and 1.0%) - store between 2-8 degrees
and minims (0.5% and 1.0%) - store below 26 degrees
How long does it take for cyclopentolate hydrochloride to be maximal and what is the recovery time?
30-60 mins and 4-12 hours
In what situation would you not give the full rx when using cyclopentolate hydrochloride?
Hyperopia with expo deviation and myopia with eso deviation
What are ocular side effects of cyclopentolate hydrochloride?
- Stinging
- Blurring
- Photophobia
- Raised IOPs
- Conjunctival hyperamia/oedema
What are general-body side effects of cyclopentolate hydrochloride?
-Dose related
- Dry mouth
- CNS effects
- Flushing
- Tachycardia
- Urinary symptoms
- GI symptoms
What are additional uses to cyclopentolate?
- Adaptation to spectacles (children normally adapt well to hyperopic rx)
Use 1% cyclopentolate daily for two weeks so then the child associates clear vision with wearing their glasses - Mydriasis
- Anterior uveitis and posterior synechiae breakdown
- Alleviation of ciliary spasm
Who can supply homatropine hydrobromide?
Additional supplier to independent prescriber- store below 25 degrees, available in 1%
What is homatropine hydrobromide used for?
Dilating pupils and alleviating a ciliary spasm
Mydriasis- 30-60 mins
Recovery 24-48 hours
