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Tropicamide has limited clinical effect on cycloplegia and mydriasis when combined with cyclopentolate and

Alain E Sherman1, Melissa M Shaw1, Hantamalala Ralay-Ranaivo2

  • 1Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|January 15, 2019
PubMed

Insights

Removing tropicamide from pediatric eye drops maintained cycloplegic effects. Mydriatic differences were clinically insignificant, ensuring adequate dilation for eye exams in children.

Area of Science:

  • Ophthalmology
  • Pediatric Eye Care
  • Pharmacology

Background:

  • Pediatric eye examinations often require cycloplegia and mydriasis.
  • Commonly used eye drops combine tropicamide, cyclopentolate, and phenylephrine (TCP).
  • The specific contribution of tropicamide to the combined effect requires clarification.

Purpose of the Study:

  • To evaluate the cycloplegic and mydriatic effects of omitting tropicamide from a standard pediatric eye drop formulation.
  • To compare the efficacy of a tropicamide-containing combination (TCP) versus a combination without tropicamide (CP).

Main Methods:

  • Prospective study of 75 children aged 4-11 years.
  • One eye received TCP; the contralateral eye received CP (cyclopentolate and phenylephrine).
  • Measured spherical equivalent, maximum pupil size, and pupillary constriction post-instillation; iris pigmentation was analyzed.

Main Results:

  • No significant difference in spherical equivalent between TCP and CP groups (P=0.95).
  • Significant interactions observed between eye drop regimen and iris pigmentation for pupil size (P=0.001) and constriction (P=0.02).
  • In children with dark irides, TCP resulted in slightly larger pupils but reduced light responsiveness compared to CP.

Conclusions:

  • TCP and CP demonstrated equivalent cycloplegic effects.
  • Mydriatic differences were statistically significant but clinically minor, with all pupils achieving sufficient dilation for funduscopy.
Abstract

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