The Cycloplegic and Mydriatic Impact of Tropicamide Omission from a Routine Pediatric Eye Drop Combination
Alain E. Sherman; Melissa M. Shaw; Hanta Ralay Ranaivo; Bahram Rahmani
Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children’s Hospital of Chicago
Introduction: This study examined the cycloplegic and mydriatic impact of tropicamide omission from a common pediatric eye drop combination.
Methods: Seventy-five children between the ages of 4 and 11 received 1% tropicamide, 1% cyclopentolate, and 2.5% phenylephrine (TCP) in one eye and 1% cyclopentolate and 2.5% phenylephrine (CP) in the other. Spherical equivalent (SE), maximum pupil size (mm), and pupillary constriction in response to photostimulation (percent change) were measured prior to and 30 minutes after eye drop instillation using an autorefractor and pupillometer. Iris pigmentation was examined as a between-subjects variable.
Results: Mean differences in SE between TCP and CP were not statistically significant (p = 0.96). Significant interactions between eye drop regimen and iris pigmentation were observed for pupil size (p = 0.001) and constriction percentage (p = 0.04). Among only patients with dark irides, TCP, on average, yielded slightly larger pupils (7.72 vs. 7.34 mm, p = 0.003) that were less responsive to light (5.66% vs. 7.62%, p = 0.003). All pupils dilated to >/= 6.0 mm, with equivalent proportions achieving >/= 7.0 mm for TCP and CP (p = 0.17).
Discussion: TCP and CP elicited equivalent cycloplegic effects. Mydriatic differences between the regimens, although statistically significant in dark irides, were of negligible clinical magnitude, and all pupils achieved sufficient dilation for funduscopy.
Conclusion: Tropicamide may be omitted from the traditional TCP pediatric eye drop regimen. Fewer drops are typically better tolerated by children and may improve cooperation with the ophthalmic exam. Omission of tropicamide would also offer cost benefits for practitioners.
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