Related Experiment Video
Updated: Sep 7, 2025
Transcutaneous Microcirculatory Imaging in Preterm Neonates
Published on: December 31, 2015
Early Hemodynamic Effects of Mydriatic Eye Drops in Preterm Infants
Emre Dincer1, Ilker Gonen2, Helen A Bornaun3
1Division of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Türkiye.
Insights
Mydriatic eye drops used for retinopathy of prematurity (ROP) screening do not significantly affect preterm infants' early hemodynamic status. Careful administration to prevent systemic absorption is recommended for this high-risk population.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Cardiology
Background:
- Mydriatic eye drops are essential for retinopathy of prematurity (ROP) examinations in preterm infants.
- Systemic adverse effects from these drops have been reported, necessitating investigation into their hemodynamic impact.
- Understanding early hemodynamic effects is crucial for managing risks in vulnerable neonates.
Purpose of the Study:
- To prospectively evaluate the early hemodynamic effects of mydriatic eye drops in preterm infants undergoing ROP screening.
- To identify potential mechanisms behind reported adverse effects.
- To assess the safety profile of standard mydriatic eye drop usage in neonates.
Main Methods:
- Prospective study including preterm infants (<32 weeks gestational age) requiring ROP examination.
- Measurement of vital signs (heart rate, respiratory rate, SpO2, blood pressure), cerebral and mesenteric tissue saturation (NIRS), and left ventricular function (echocardiography) before and after administering 2.5% phenylephrine and 0.5% tropicamide.
- Statistical comparison of pre- and post-administration data with strict protocols to minimize systemic absorption.
Main Results:
- Thirty-two procedures in 26 preterm infants (mean gestational age 28.5 weeks) were analyzed.
- No statistically significant changes were observed in vital signs, NIRS values, or echocardiographic findings post-mydriatic eye drop administration.
- No adverse reactions were documented during the study period.
Conclusions:
- This study is the first to comprehensively assess early hemodynamic effects of mydriatic eye drops in preterm infants using multiple monitoring methods.
- Mydriatic eye drops, when administered cautiously to prevent systemic absorption, appear to have no significant immediate hemodynamic impact on preterm infants.
- Emphasizes the importance of meticulous administration techniques to mitigate potential risks in this susceptible population.
Objective:
Mydriatic eye drops used for retinopathy of prematurity (ROP) examination can cause systemic effects, and there are case reports of serious adverse effects in the literature. In this prospective study, we aimed to evaluate the early hemodynamic effects of mydriatic eye drops to understand the possible mechanisms of adverse effects.
Study Design:
Between December 2018 and March 2019, preterm babies less than 32 gestational weeks and who underwent ophthalmologic examination in our unit were included. The vital signs (heart rate, respiratory rate, oxygen saturation [SpO2], and blood pressure values), cerebral and mesenteric tissue saturation by near-infrared spectroscopy (NIRS), and left ventricular functions of infants were recorded before and after applying mydriatic eye drops (2.5% phenylephrine and 0.5% tropicamide). The data were compared statistically. Strict adherence to prevent systemic absorption of the eye drops was applied.
Results:
Thirty-two mydriasis procedures were evaluated in 26 patients. The mean gestational age was 28.5 ± 1.7 weeks, and the mean birth weight was 943 ± 233 g. There were no significant differences in terms of vital signs of infants including heart rate, blood pressure, and oxygen saturation [SpO2] levels before and after eye-drop application. In addition, NIRS values showed no significant differences between before and after measurements. No significant differences were detected at echocardiographic evaluation performed before and after mydriatic administration. No adverse reaction was observed in the study population during the study.
Conclusion:
This is the first study that evaluated the early hemodynamic effects of mydriatic eye drops used for ROP screening by vital signs, NIRS, and echocardiographic evaluation. Mydriatic eye drops have no significant effect on early hemodynamic parameters including vital signs, NIRS, and echocardiographic findings in preterm infants. We suggest that a cautious approach for avoiding the systemic absorption of these agents may prevent the possible early systemic effects in this high-risk population.
Key Points:
· Mydriatic eye drops are commonly used for pupil dilatation before retinopathy of prematurity examination, and there are reports of serious adverse events caused by these drops.. · Due to the adverse events of eye drops, hemodynamic effects of these agents were investigated by clinical findings, near-infrared spectroscopy, and echocardiography.. · No significant early hemodynamic effect was observed so avoiding systemic effects may be prevented with precautions..
