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Effects and side effects of mydriatic eyedrops in neonates
1Department of Ophthalmology, Marmara University Faculty of Medicine, Haydarpasa Numune Hospital, Istanbul, Turkey.
Insights
Tropicamide is the safest pupil dilation drop for neonates, while phenylephrine combinations show maximum side effects. Group F achieved the largest pupil dilation for retinal exams.
Area of Science:
- Ophthalmology
- Neonatal Medicine
- Pharmacology
Background:
- Pupil dilation is crucial for neonatal retinal examinations.
- Current dilation drops carry known risks and side effects in infants.
Purpose of the Study:
- To evaluate the efficacy and safety of various mydriatic agents in neonates.
- To compare the side effects of different combinations of cyclopentolate, tropicamide, and phenylephrine.
Main Methods:
- A prospective randomized study involving 80 healthy neonates.
- Assignment to eight groups using different combinations of cyclopentolate, tropicamide, phenylephrine, or saline.
- Monitoring of vital signs (heart rate, blood pressure) and pupillary size under intense light.
Main Results:
- Group C (2.5% phenylephrine) exhibited the most significant side effects.
- Group B (1% tropicamide) was identified as the safest option.
- Group F (0.5% cyclopentolate, 0.5% tropicamide, 2.5% phenylephrine) achieved maximum mydriasis.
Conclusions:
- Tropicamide monotherapy is the safest mydriatic agent for neonatal retinal examinations.
- Combination therapies, particularly those including phenylephrine, increase the risk of adverse events.
- Optimizing mydriasis for examination requires careful consideration of drug combinations and potential side effects.
Abstract:
The pupils of neonates and premature infants often need to be dilated for retinal examination. The drops used for this purpose have some known side effects. This study investigated the effects and side effects of these drops. In this prospective randomized study, 80 healthy neonates were randomly assigned to eight groups. In Group A 1% cyclopentolate was used; in Group B 1% tropicamide; in Group C 2.5% phenylephrine; in Group D 1% cyclopentolate and 1% tropicamide; in Group E 2.5% phenylephrine and 1% tropicamide; in Group F 0.5% cyclopentolate, 0.5% tropicamide and 2.5% phenylephrine; in Group G 1% cyclopentolate and 2.5% phenylephrine and in Group H 0.9% NaCl. Heart rate, systolic and diastolic blood pressures were recorded before, and 5, 10, 15, 30, 45, 60 minutes after instillation of the drops. Pupillary size was measured at baseline, 30 and 60 minutes. To stimulate the conditions of indirect ophthalmoscopic examination, the pupil sizes were measured under the intense beam of a halogen light. The results were analyzed statistically. Maximum side effects were seen in group C; the safest was group B and maximum mydriasis was achieved in group F.