Mydriatics and Cycloplegics (M1)

Question 1

What is the pathway of the sympathetic nervous system to the iris?

Answer 1

Ciliospinal nucleus of Budge to the superior cervical ganglion then up along the internal carotid then along ophthalmic artery to the alpha receptors of the iris dilator muscle

Question 2

What is the pathway of the parasympathetic nervous system to the iris?

Answer 2

Edinger-Westphal nucleus to ciliary ganglion to the iris sphincter

Question 3

What is more robust dilation technique? 1. What is a side effect of this? 2

Answer 3

1. inhibiting sphincter with parasympatholytic

2. cycloplegia occurs

Question 4

What is the mechanism of sympathomimetics on the iris?

Answer 4

innervation of alpha1 receptors on iris dilator muscles

Question 5

When is a cycloplegic refraction required?

Answer 5

1. Infants, toddlers, and peds patients
2. Latent hyperopes
3. Pseudomyopia, accommodative spasm
4. Esotropia, high esophoria
5. Pre-op refractive surgery

Question 6

What muscarinic receptor type is most common in the receptors of the iris and CB?

Answer 6

M3

Question 7

What muscarinic receptor is in the longitudinal fibers of CB, affecting axial length growth and therefore myopia control?

Answer 7

M1

Question 8

What did the ATOM 1 study show?

Answer 8

1% atropine reduced progression of myopia in 77% over 2 years but side effects of cyloplegia and mydriasis were high

Question 9

What did the ATOM 2 study show?

Answer 9

compared effects on myopia progression of 0.5%, 1%, and 0.01% atropine and showed all were successful in myopia control

Question 10

What is the combination used for DFE of first eye exam pediatric populations?

Answer 10

1. 1gt 1% tropicamide

2. 1% cyclopentolate

Question 11

What pregnancy category is tropicamide and phenylephrine?

Answer 11

category C

Question 12

If you must dilate a pregnant female, what should be used?

Answer 12

tropicamide

Question 13

What time period during pregnancy should DFE definitely be avoided?

Answer 13

during 1st trimester

Question 14

What contraindications of pupil dilation?

Answer 14

1. Iris fixed IOL

2. angle at risk for acute angle closure glaucoma

Question 15

What are the risk factors for angle closure?

Answer 15

1. narrow anatomical angles
2. shallow anterior chamber
3. short axial length
4. hyperopia
5. age

Question 16

What vector forces does the iris dilator contribute?

Answer 16

lateral and posterior

Question 17

What vector forces does the iris sphincter contribute?

Answer 17

anterior and medial

Question 18

Which drug type is more important to avoid if there is a possibility for angle closure?

Answer 18

sympathomimetics