Paediatric cycloplegia: a new approach
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Insights
Using proxymetacaine before cyclopentolate eye drops significantly reduces distress in children. This atraumatic approach improves the child
Area of Science:
- Ophthalmology
- Pediatric Care
Background:
- Cycloplegia using cyclopentolate eye drops is often traumatic for children due to stinging.
- This discomfort can lead to inadequate cycloplegia, examination difficulties, and patient anxiety.
- Proxymetacaine hydrochloride 0.5% is a non-stinging topical anesthetic.
Purpose of the Study:
- To evaluate the efficacy of proxymetacaine in preventing discomfort associated with cyclopentolate-induced cycloplegia in children.
- To assess the impact of pre-treatment with proxymetacaine on children's experience during ophthalmic examinations.
Main Methods:
- Eighty-eight pediatric patients were assessed in a clinical setting.
- Parental reports using a grading scale evaluated responses to prior cyclopentolate use.
- The same grading system assessed patient response to proxymetacaine followed by cyclopentolate.
Main Results:
- Seventy percent of children experienced distress (crying, unhappiness) with cyclopentolate alone.
- Ninety-one percent of children showed no adverse reaction and remained comfortable when proxymetacaine preceded cyclopentolate.
- Pre-treatment with proxymetacaine dramatically improved patient comfort during cycloplegia.
Conclusions:
- Pre-instillation of proxymetacaine renders cyclopentolate-induced cycloplegia atraumatic in pediatric patients.
- This method enhances the doctor-patient relationship by reducing fear and improving cooperation.
- Atraumatic cycloplegia is achievable and beneficial in pediatric ophthalmology.
Background:
Cycloplegia is a traumatic experience for most children, as guttae cyclopentolate stings on instillation into the conjunctival sac. This may result in inadequate cycloplegia, difficulty in further examination and a child who is scared of both the doctor and the ophthalmology department. Guttae proxymetacaine hydrochloride 0.5% (Ophthaine, Proparacaine) is a topical local anaesthetic that does not sting on instillation.
Methods:
Eighty-eight consecutive children in the paediatric clinic were assessed. The response of the patient to previous use of cyclopentolate alone was assessed by the parents of the child using a grading scheme. The use of proxymetacaine prior to instillation of cyclopentolate was then assessed using the same grading system.
Results:
Seventy per cent of the children who received cyclopentolate alone were assessed to have cried and been unhappy. Ninety-one per cent of the children who received cyclopentolate after proxymetacaine were assessed to have shown no adverse reaction to the cycloplegia and remained happy.
Conclusion:
This study shows that use of proxymetacaine prior to cyclopentolate results in atraumatic cycloplegia in children. This can confer multiple benefits on the doctor-patient relationship.
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