Mydriatics, cycloplegic and cyclotonic drugs. Drops that dilate the pupil of the eye - mydriatics in ophthalmology Mydriatics indications for use
To thoroughly diagnose the organs of vision, use special drops- to dilate the pupils. These drugs are called mydriatics, and their use is necessary condition for diagnosing most eye pathologies.
Except diagnostic value With the help of drops you can eliminate some symptoms of diseases of the organs of vision. In the article we will look at the features of drops for dilating pupils, find out in what cases they can be used, find out whether the drugs have side effects, and provide a list of the most popular mydriatic drugs.
Purpose of drops and duration of exposure
So, in ophthalmology, mydriatic drops are usually used to solve two problems:
- for diagnostics;
- for treatment.
As for the first point - diagnosis, without high-quality and sufficiently long dilation of the pupils, conduct a more or less reliable and thorough examination fundus almost impossible.
Mydriatics are necessary for diagnostic studies all retinal diseases, as well as to detect visual acuity.
In diagnostic medicine, drops of this category are used mainly:
- for the study of retinal pathologies;
- analyzing the condition of the lens, determining the degree of its transparency;
- studies of blood vessels of the visual organs;
- optic nerve;
- if necessary, detect detachment, dystrophy, and other pathologies of the visual organs.
Find out what retinal angiopathy looks like in a child.
Additionally, you can pass if the diagnosed person is going to drive. To determine the level of visual impairment, the degree of myopia or farsightedness, drops are also necessary. When applied to young children, drops with the effect of dilating the pupils are necessary to determine such an indicator as refraction. To correctly select glasses with the required number of diopters, the use of these drops is also useful.
In therapy, drops that dilate the pupils are used in the following diseases:
- iritis;
- amblyopia;
- iridocyclitis;
- false myopia.
More details about what high-grade amblyopia looks like in children can be found in.
As for the duration of exposure, mydriatic drops can dilate the pupils for either several hours or a week. It all depends on the purpose: sometimes a short time is enough for an examination, but long-term exposure is necessary for treatment.
In the video - drops for dilating pupils:
However, we note that long-acting drops usually have more contraindications, side effects, and cause more severe discomfort than “short-term” drugs. The most common discomfort symptoms include tearing in bright sunlight or artificial light. The average duration of exposure to drops is from three to four hours.
Any eye drops should be prescribed only by a medical professional: amateur activity is unacceptable here. An illiterate choice of remedy and its incorrect use can lead to serious consequences, complications, even intoxication of the body.
Kinds
Mydriatic drops are divided into two categories:
- straight;
- indirect.
Direct acting drugs contract the radial muscles of the eyes. These include drugs such as Phenylephrine and. Direct drops have a noticeable dilating effect on the pupil.
Indirect action drops have an impact on the circular eye muscle, reduce the intensity of its contractions. These drugs simultaneously dilate the pupils and adjust the focus of vision. This includes such products as Cyclomed, Midrum. When using “indirect” drops, a short-term loss of vision usually occurs: immediately after instillation. After a few minutes, vision is restored.
All drops differ in the time of their action, but those drugs that are used exclusively for diagnostic purposes have the same duration: shorter than usual. This is due to the fact that a few hours are enough to conduct a high-quality examination.
Interesting: mydriatic drops have a longer duration of action when the iris of the eye is light.
Find out why the size of the pupils is different and why this manifestation is dangerous.
Review of drugs - names and descriptions
Let's look at the drops most commonly used in modern ophthalmology to dilate the pupils.
Atropine - how to instill it to get examined by an ophthalmologist
The medicine contains a substance that was used several centuries ago by ladies trying to attract the attention of men. This component of the drops makes the look languid and expressive - which, in fact, is what the ladies were looking for. Modern women They do not set such a goal for themselves, and use Atropine exclusively for medicinal purposes.
Cost from 15 rub.
The effect of the drug occurs due to a powerful plant alkaloid - atropine sulfate. This substance leads to temporary paralysis of the oculomotor nerve, due to which, in fact, the pupil dilates. The drug is useful in research and can also be used in the treatment of uvitis.
Note that now this medicine is used less and less, as new, more safe drugs with a similar effect. The fact is that Atropine is toxic and leads to temporary blurred vision and discomfort.
The exposure time of the drug is very long - it can dilate the pupils for a week, or even 10 days. Not recommended for use this remedy without permission, without medical prescription.
The drug Midriacil for the eyes (Midrium, Topikamid) - how it works, does it dilate the pupils
The product begins to act quickly (literally 15 minutes after instillation), and dilates the pupils for several hours. As a rule, the effect lasts for three hours, no more. Due to the short exposure time, the drug has minimal side effects. The medicine can be used for diagnostic and therapeutic treatment children.
Midriacil is used before fundus examinations for diagnostic purposes, for the treatment of certain diseases, for assessing refraction, during operations on retina or lens. Use this drug with caution if you have inflammatory processes organs of vision, as well as high blood pressure intraocular fluid.
Price from 350 rub.
How to instill Irifrin to enlarge pupils for a vision test
The drug has a short duration of action and can be used for both diagnosis and therapy (with increased intraocular pressure).
Irifrin should not be used if the child is under 12 years old; the drug is also prohibited for the treatment of older people with pathologies of the heart and blood vessels.
Effect of the drug Cyclomed
It is one of the most popular mydriatics today. The product has a long-lasting effect - 6-12 hours. It has a safe composition and can be used even by women during pregnancy and breastfeeding. The drug can be useful both for diagnostic purposes and in the treatment of diseases (uevitis, keratitis, scleritis). In addition, it is often used during eye surgery, in particular during cataract removal.
As for children, Cyclomed can be used when the child is over three years old. But for treatment and diagnosis eye diseases The drug should not be used in elderly people. In addition, the use of Cyclomed is prohibited if there are diseases such as intestinal obstruction and prostate adenoma.
Interesting information on the topic! Find out how cataract phacoemulsification works and how effective it is this procedure.
Mezaton eye remedy, which temporarily dilates the pupil
The product is dropped to enlarge the pupils of the eyes. It has a number of contraindications: pregnancy, pancreatitis, atherosclerosis, hepatitis, lactation.
Cost from 90 rub.
Attention: if you have existing glaucoma, the use of any mydriatic drops is prohibited.
How to drip Appamide plus to dilate pupils
As a rule, when diagnosing eye diseases in children, the volume of the medicine is reduced, and the drug lasts only an hour. For adults - at least two hours. Due to the short-term effect of the drug, it is usually used only for diagnostic purposes and is not used for treatment.
Side effects
Note that when mydriatics are instilled into the eyes, the components of the drugs enter the bloodstream, after which they spread throughout the body. That is why, after using the products, a whole “bouquet” of all kinds of side effects can be observed. Let's look at the most common side effects.
- defect of visibility in the form of splitting of objects, things;
- blurred vision;
- increased intraocular fluid pressure;
- redness of the conjunctiva of the eye, eyelids, cornea;
- photophobia and painful sensations, burning;
- thirst combined with difficulty urinating;
- irritability, nervous restlessness;
- heat.
If, after instilling the drug, you experience one or more of the listed symptoms, you should seek medical attention as soon as possible. medical assistance. Probably needed symptomatic treatment, as well as repurposing the drug.
If an overdose of mydriatics is allowed during instillation, the following symptoms are likely to develop:
- dry skin, mucous membranes;
- eating disorders;
- speech behavior defects;
- tachycardia;
This makes the usual side effects worse.
If the excess dose of drops was very serious, it is likely even coma due to paralysis of the respiratory center.
We learned what mydriatic drops are and what they are used for. As you can see, the use of these medications is indispensable both in the diagnosis of eye diseases and in treatment. Be sure to visit your doctor if you experience any vision problems, and follow the instructions for using the prescribed drops.
We reveal the essence of what “mydriasis” and “cycloplegia” are
Since ancient times, doctors of all specialties have used terms in their speech that are incomprehensible to patients. In Victorian England (1837-1901) there was a saying, “The Belle of the Ball.” It contains a play on words: “bella” - beauty, “ball” - ball. The fact is that women in those days often used drops of belladonna extract to dilate their pupils, which made them more attractive. The belladonna plant (translated from Italian as “beautiful woman”) contains atropine, which belongs to the class of mydriatics. Their use by ophthalmologists will be discussed in this article.
Terms and theory
Doctors' explanations often do not reflect the essence medical concept. Let’s try to reveal the meaning of the terms “mydriasis” and “cycloplegia”. The eyes can be relaxed with drops called mydriatics. They dilate the pupil and also cause paralysis of the ciliary muscle, which is located inside the eye and controls focusing (). Paralysis of the ciliary muscle is called cycloplegia. Medicinal mydriasis is the dilation of the pupil with the help of drops. “Cycloplegia” is a term that consists of two Latin words: “cyclo” is an anatomical concept designating the ciliary body in which the muscle ring (ciliary muscle) is located; "plegia" is relaxation. That is, the whole term means “relaxation of the ciliary body.”Next, you need to take an excursion into the anatomy of the visual system, which includes the right and left eyes, pathways, subcortical visual centers and the brain (Fig. 1). I would like to immediately note that we look with our brains, not with our eyes. The visual system has basic visual functions, seven of them:
- visual acuity;
- contrast sensitivity;
- line of sight;
- color discrimination;
- adaptation (light and dark);
- oculomotor function;
- binocular vision.
Rice. 2. The usual type of elastic lens (up) and changing its shape to “rounded” when focusing vision on a close object (at the bottom)
Now we need to understand the terms “ciliary body”, “ciliary muscle”. “Cilia” (from Latin cilia) is a “shoot”. Indeed, the ciliary body consists of two parts: the first - with processes, the second - flat.
Inside the ciliary body (the part with the processes) is the ciliary muscle; it is called the “heart of the eye” because it must contract and relax all the time, just like the heart muscle. When the ciliary muscle contracts, the ligaments contract, and the lens changes its shape, that is, it becomes spherical (see Fig. 2).
Under natural conditions, the ciliary muscle can relax when we look into the distance or are in a darkened room. However, in children, adolescents and young adults, the ciliary body is in a spastic (tense) state, and the lens has a more spherical shape, in contrast to the lens of older people.
So, let's get down to it complex concept- “vascular tract of the eye.” Eyeball has a layered structure: outer shell formed by the cornea and sclera, the inner one is the retina. Between them is a vascular tract consisting of three parts:
- the iris (responsible for the color of the eye), in the center of which there is a hole - the pupil;
- ciliary body (within it there is the ciliary, or accommodative, muscle);
- the choroid itself.
Examination by an ophthalmologist
Ophthalmologists who examine the patient use mydriatics - eye drops that dilate the pupil (Mydriacyl, Cyclomed, Midrimax and atropine; Fig. 3). With a wide pupil, the periphery of the fundus is examined, where the specialist can identify dystrophic changes and even retinal detachment, and the structures of the eye are examined using a slit lamp. 
Rice. 3. Eye drops, dilate the pupil (from left to right): “Midriacyl”, “Cyclomed”, “Midrimax” and atropine
Professor Yu. Z. Rosenblum recommends selecting glasses in four stages:
I. Examination of the patient in natural conditions. Purpose: determination of the static refraction of each eye.
II. Examination in conditions of cycloplegia. Goal: accurate determination of the static (clinical) refraction of each eye.
III. Final examination in natural conditions. Objectives: assessment of the state of dynamic refraction and binocular functions and, based on the results obtained, selection of correction for distance and reading.
IV. Examination of the patient wearing ready-made glasses. Purpose: checking the correctness of the glasses manufactured and the patient’s tolerance, if necessary, changing the prescribed correction.
Let's take a closer look at stage II - examination in conditions of cycloplegia. Cycloplegia is a drug-induced paralysis of the ciliary muscle. The gold standard for cycloplegia is instillation of atropine drops into age dosage(atropine 0.1% - in the first year of life, 0.5% - at 5 years, 1% - at 10 years and older). The drug is instilled 2 times a day, morning and evening, after meals, one drop for 3 days.
Significantly more often used means of milder and short-term action: “Cyclomed” 1%, “Midriacyl” 1%. These solutions are instilled one drop at a time 2 times with an interval of 10 minutes. After cycloplegia, an ophthalmologist can perform retinoscopy (skiascopy) and obtain data on cycloplegic refraction and identify disturbances in the optical system of the eye.
The iris and ciliary body have the same innervation (oculomotor nerve), therefore, with cycloplegia, the pupil dilates (medicinal mydriasis).
Answers to readers' questions
In what cases is medical cycloplegia necessary?Cycloplegia is necessary when selecting glasses for a patient, when an ophthalmologist needs to examine optical system eyes; At the same time, mydriatics are instilled into both eyes according to the scheme. If moderate and high hypermetropia, all degrees of myopia, and astigmatism are detected, the doctor will prescribe corrective glasses. With full correction refractive errors() the clinical focus of the rays will be moved to the center of the retina ( yellow spot), which will make it possible to see clearly and obtain high visual acuity.
Is the implementation of cycloplegia different in children and adults?
Yes. It is necessary to use mydriatics in dosage taking into account the patient's age.
What medications are used for this procedure? Are they safe?
For cycloplegia, mydriatics are used. When instilling mydriatics, like any other drugs, local allergic reactions: redness, swelling of the eyelids and conjunctiva, as well as general reactions: headache, redness skin, increased body temperature, dry mouth, decreased blood pressure, collapse and convulsions. Mydriatics are contraindicated in patients with, with hypersensitivity to drugs.
How should a patient behave after a cycloplegia procedure? Are there any restrictions regarding visual stress, driving, etc.?
During the period of action of mydriatics, until the initial pupil width and visual acuity are restored (when instilling “Mydriatsil” it takes 6 hours, when using “Cyclomed” - 3 days, when using atropine it takes 1 week), you need to refrain from driving a car, it will be difficult to read and work at the computer.
Can a patient refuse cycloplegia? When is it advisable to do this? Can a conscript refuse cycloplegia?
The patient can refuse any manipulation. When visiting an ophthalmologist, be aware that dilation of the pupil (fundus examination, slit lamp examination, and clinical refraction examination) may be necessary. You must come to the appointment with an accompanying person; it is not advisable to arrive in your own vehicle. If a conscript comes to see an ophthalmologist at the military registration and enlistment office, then he should not refuse instillation of mydriatics, since an in-depth examination with a wide pupil is carried out solely in his interests.
During ophthalmological examination instillation of mydriatics is a necessary procedure that can reveal changes in the retina and more accurately determine cycloplegic refraction.
Zoya Evgenievna Kotina,
ophthalmologist, teacher at the Northwestern Higher Medical School
Cycloplegics and mydriatics are drugs widely used in ophthalmology for assessing the refraction of the eye (including when making expert decisions), examining eye structures that are difficult to visualize, and conducting differential diagnosis of certain diseases, preoperative preparation and for medicinal purposes.
Examination under conditions of cycloplegia is indicated if latent farsightedness, accommodative spasm or strabismus are suspected.
Ideal mydriatic– a drug that does not weaken accommodation and does not cause side effects. Given that anticholinergics affect the ciliary muscle, it would seem that sympathomimetics are most suitable for these purposes. However, everything is not so simple. When comparing tropicamide and phenylephrine, the first one is still preferable, since it provides more pronounced mydriasis in a shorter time and is safer to use.
In adults, a combination of these can be used for adequate mydriasis. Some researchers have noted similar effectiveness of these drugs at lower concentrations than in single drugs (Krumholz et al 2006). Research by Fan et al (2004) found that children over 5 years of age with dark color iris, the combination of 0.5% tropicamide + 0.5% phenylephrine had a similar effect to 1.0% tropicamide + 1.0% cyclopentolate. Studies by Hamasaki et al (2007), Ebri et al (2007) also indicate greater effectiveness of the combinations of drugs described above compared to single drugs.
Patients with highly pigmented irises may require a higher concentration of mydriatics to achieve effect. Also, certain conditions (for example, senile miosis in the elderly, denervated pupil in patients with diabetes, especially those who have undergone laser photocoagulation of the retina for proliferative retinopathy) may reduce the response of the iris sphincter to the action of these drugs. In such individuals, the use of a combination of 0.5% tropicamide solution and 10% phenylephrine is indicated.
Ideal cycloplegic is a drug that has a quick but short-term effect that completely relaxes accommodation and has no local or systemic side effects.
Characteristics of the most commonly used cycloplegics
(source: Clinical Ocular Pharmacology, 5th edition by Jimmy D. Barrett et al.)
Unfortunately, this is currently medicine has not yet been synthesized, and everything in the arsenal has one or another negative qualities. In most countries of the world, the short-acting cycloplegics most often used are tropicamide and cyclopentolate. However, their characteristics do not allow us to completely abandon atropine, which is currently, not without reason, the “gold standard” for cycloplegia.
Let's try to understand the reasons for this.
Comparison of the effectiveness of cyclopentolate and atropine
Some studies indicate that there is no statistically significant difference in effectiveness between 3-fold instillation of a 1% solution of cyclopentolate after 15 minutes and instillations of the same concentration of atropine solution three times a day for 3 days.
However, most others, on the contrary, indicate a weaker effect of cyclopentolate compared to atropine. Thus, in one of them, in a group of children under 6 years of age, on average, 0.66 D more of latent hyperopia is detected, and in those over 7 years of age, 0.77 D of more latent hypermetropia is detected when using atropine. In another, after instillation of a 1% solution of this drug, 0.66 D more latent hyperopia was revealed than using a combination of 1% solutions of tropicamide and cyclopentolate.
In another study in 1-year-old children, atropine detected an average of 0.4 D more hyperopia than cyclopentolate. When using atropine in children aged 3 months to 6 years with esotropia, 0.34 D more hyperopia was detected than using cyclopentolate. In the same study, in a subgroup where initial cycloplegia with cyclopentolate revealed hyperopia greater than 2.0 D, subsequent instillations of atropine additionally revealed 1.0 D or even more latent hyperopia. Fan et al (2004) recommended a 1% atropine solution as the most effective cycloplegic in children under 5 years of age with darkly pigmented irises and strabismus.
Comparison of the effectiveness of cyclopentolate and tropicamide
There is also no consensus among scientists regarding this issue. In recent years, several comparative studies have been conducted between cyclopentolate and tropicamide. One of them found no clinically significant differences when measuring the degree of ametropia in healthy children aged 4-7 months.
Other studies have noted that cyclopentolate and tropicamide may have similar effectiveness in determining cycloplegic refraction in children (Egashira et al 1993, Mutti et al 1994, Lin et al 1998, Owens et al 1998, Manny et al 2001, Luke L.-K. Lin et al 2009). Twelker and Mutti (2001) compared the results of retinoscopy in children aged 4-7 months after instillation of a 1% solution of tropicamide or cyclopentolate and concluded that there was no difference in their effectiveness in healthy children younger age.
Another study conducted among patients 6-12 years old without amblyopia and strabismus with farsightedness up to 4.5 D also found no differences in the assessment of refraction, but the amount of residual accommodation after the use of tropicamide was 0.39-0.56 D more .
Residual accommodation, determined push-up method
, after instillation of a 1% solution of tropicamide into one eye (after 30 minutes) and a solution of cyclopentolate of the same concentration (after 60 minutes) into the other
(source: Clinical Ocular Pharmacology, 5th edition by Jimmy D. Barrett et al).
| Age (years) | Tropicamide (Dopters/number of patients) | Cyclopentolate (Dopters/number of patients) |
| 0-9 | 6,25/6 | -/0 |
| 10-14 | 3,65/20 | 1,6/5 |
| 15-19 | 3,2/7 | 1/3 |
| 20-29 | 3,1/7 | 1,4/7 |
| 30-39 | 2,6/7 | 2/7 |
| over 40 | 1,7/3 | 1,1/3 |
Hofmeister et al (2005) found that 1% cyclopentolate solution was more effective than tropicamide in reducing the amplitude of accommodation in adult patients. However, no statistically significant difference in the results of determining cycloplegic refraction between the drugs was detected. Interestingly, patients reported better tolerability of tropicamide instillations.
conclusions
The use of atropine is primarily indicated in children with moderate and high degree hypermetropia and esotropia. It is most often used in young children, as it has the ability to completely paralyze accommodation. It can also be used in the treatment of amblyopia (penalization).
With cyclopentolate and tropicamide, complete cycloplegia cannot be achieved, as with atropine, especially in children 6-16 years old. In this regard, the statement of Gettes (1961), often mentioned in foreign literature that a cycloplegic agent is considered effective when the residual accommodation is less than 2.5 D.
Cyclopentolate begins to have a cycloplegic effect faster than atropine and has a more short period actions. In this regard, it is used more widely today and has practically replaced atropine from practice, since it avoids long-term blurred vision that complicates daily activities, has a lower risk of side effects, and has a more complete cycloplegic effect compared to tropicamide.
Due to better absorption through the cornea, tropicamide begins to act earlier than cyclopentolate, and the duration of the effect is even shorter. It can also be used to determine cycloplegic refraction in patients without amblyopia, strabismus, children with myopia or mild hyperopia, and adults. However, one cannot fail to note sometimes significant residual accommodation after use, which still makes it not the best cycloplegic, especially for patients childhood.
It is important to remember that it is advisable to use a 0.5% solution of tropicamide only for the purpose of dilating the pupil or due to the lack of an alternative in young children, since its effect on the ciliary muscle varies in different patients and may not block up to 2 D of residual accommodation.
Despite big list side effects, with proper use of cycloplegic drugs the risk of their development is low. Loewen and Barry (2000) retrospectively assessed the experience of 57 medical centers, where a total of 1.7 million cycloplegies were performed. The development of complications requiring observation for several hours or hospital treatment was noted only in 47 and 2 cases, respectively.
Strict adherence to instillation rules eye drops will reduce systemic absorption of the drug and reduce the risk of side effects.
In all patients who are to be prescribed cycloplegics and mydriatics, it is advisable to assess the depth of the anterior chamber to prevent closure of the atrial cavity and significant increase IOP. After completion of the cycloplegic effect, IOP control is recommended, especially in patients with glaucoma. Thus, the described drugs in most cases slightly increase it, however, in one of the studies it was noted that the use of a combination of 1.0% tropicamide + 2.5% phenylephrine in 32% of examined patients with open-angle glaucoma increased IOP by 5 mm Hg. Art. or more, and in 12% - by more than 10 mm Hg. Art..
Rengstoff and Daughty (1982), after using a 0.5% tropicamide solution, found closure of the apex and a significant increase in IOP in 33% of patients with an initially narrow apex. Portney and Pupillae (1995) noted an increase in IOP of only less than 5 mmHg. Art. in patients with open-angle glaucoma after using 1% tropicamide.
At the same time, a review of scientific articles published from 1933 to 1999 showed that the risk of developing glaucoma induced by tropicamide instillations is close to zero, since not a single such case was recorded. Pandit & Taylor (2000) concluded that even the presence of glaucoma does not increase this risk. Pukrushpan et al (2006) noted that IOP after pupil dilation with tropicamide in patients with and without open-angle glaucoma was equivalent to that before instillation, although there was a significant narrowing of the UG. In this regard, the authors do not see the need for routine repeat tonometry, but suggest performing it only when necessary.
Preliminary instillation of anesthetics before instillation of cycloplegic drugs can be considered rational, which can significantly reduce pain in children. Thus, Shah et al (1997) noted in a study that 70% of pediatric patients cried after instillation of cyclopentolate, while 91% of those who were initially instilled with proximetacaine (an anesthetic) tolerated the procedure calmly.
Preliminary use local anesthetics before instillation does not affect the severity of mydriasis from the administration of tropicamide and can even intensify it, as with owl local application with phenylephrine (Haddad et al 2007, Keller & Chang 1976).
During the period of cycloplegia or after dilation of the pupils, patients are recommended to wear sunglasses, and, if necessary, glasses for near vision.
During examination of the organs of vision, especially when examining the fundus, and when performing laser vision correction, it is important to achieve a dilated pupil. To achieve this effect, mydriatics are widely used. The following are some of the most commonly used remedies in this group.
Frequently used
0.5% or 1% solution. Maximum pronounced mydriatic and cycloplegic effects. Severe mydriasis occurs after 40 minutes, the drug is effective for two weeks.
Atropine has significant side effects. Should not be used in patients with angle-closure glaucoma, various disorders of cardio-vascular system, as well as for astigmatism, especially since for this pathology he recommends toric lenses. With caution in children and pregnant women. Other drugs cause less severe side effects than atropine.
Rarely used
- Tropicamide 0.5 and 1%. An analogue of atropine that reduces the action of the parasympathetic nervous system on the constrictor pupillary muscle and the ciliary body. Pronounced mydriatic and weak cytoplegic effects are achieved. After 30 minutes, the maximum effect develops. The duration of exposure to the substance is approximately 6 hours. To examine the fundus, use 1 drop in each eye. WITH therapeutic purpose every day for a week, use 1 drop in the evening.
- Phenylephrine 2.5%. Usually used in combination with tropicamide, increasing pupil dilation. Especially in patients with dark iris. The onset of the effect is 30 minutes, duration is no more than 5 hours.
- Cyclopentolate (Cyclomed), 1% solution in drops. Short-acting mydriatic. As a rule, it is used in the study of refraction and accommodation in children. The effect is established after 30 minutes. Duration of action is more than 24 hours. For diagnostic purposes, the drug is instilled 1 drop at a time, if necessary, repeat the instillation twice after 10 minutes; to achieve the effect of cycloplegia, you can apply 1 drop three times after 20 minutes between instillations. For treatment, use one drop 3 times a day.
It is important to note that the use of these drugs can cause a variety of adverse reactions in the form of allergies, increased intraocular pressure, an attack of angle-closure glaucoma, complications from the cardiovascular system and others. Recommendation from specialists is required before using these medications.
Phenylephrine hydrochloride
Hydroxyamphetamine hydrobromide
Atropine sulfate
Cyclopentolate hydrochloride
Homatropine hydrobromide
Scopolamine hydrobromide
Tropicamide
Phenylephrine hydrochloride
(Phenylephrine hydrochloride)
Agonist of a-sympathomimetic receptors. It has a vasoconstrictor effect and causes pupil dilation.
Available in the form of 2.5 and 10% solutions. The effect of mydriasis occurs after 30-60 minutes and lasts 3-5 hours.
Hydroxyamphetamine hydrobromide
(Hydroxyyamphetamine hydrobromide)
An adrenergic drug whose sympathomimetic effect is realized by the release of endogenous norepinephrine from the intact endings of adrenergic nerve fibers. Thus, hydroxyamphetamine is an indirect-acting sympathomimetic. Since the drug itself does not act directly at the receptor level, pupil dilation does not occur if there is damage to the nerve conductor, for example, with Horner's syndrome.
Used to achieve a state of mydriasis with routine diagnostic tests and, if necessary, short-term pupil dilation. The drug causes clinically significant pupil dilation only in cases of partial cycloplegia. The effect of the drug begins 15 minutes after instillation of one drop of the solution and reaches a maximum 60 minutes after instillation. Clinically significant pupil dilation, suppression of the pupil's reaction to light and partial cycloplegia persist for 3 hours. The reverse development of these changes begins within 90 minutes after use of the drug and in most cases is completely completed after 6 - 8 hours.
The drug should not be used in patients with angle-closure glaucoma or with a narrow anterior chamber angle, when pupil dilation can provoke an attack of angle-closure glaucoma. It is known that the use of the drug in patients with open-angle glaucoma can cause a transient increase in intraocular pressure.
Atropine sulfate
(Atropine sulfas)
An anticholinergic drug that acts directly on smooth muscle tissue and secretory glands innervated by cholinergic nerve fibers. Blocks the action of acetylcholine, as well as parasympathomimetic drugs.
The indication for the use of atropine sulfate is the need to develop mydriasis and cycloplegia to clarify refractive indices and relax the ciliary muscle in acute inflammatory conditions of the anterior part of the uveal tract.
The drug should not be prescribed to patients with angle-closure glaucoma.
Long-term use of atropine sulfate can cause systemic reactions, locally - irritation, swelling, hyperemia, follicular conjunctivitis and dermatitis.
Atropine sulfate is instilled in concentrations of 0.5, 1, 2 and 3%.
Atropine sulfate begins to act 45 to 120 minutes after instillation, and the duration of action lasts from 7 to 14 days.
Cyclopentolate hydrochloride
(Cyclopentolate hydrochloride)
Available in the form of 0.5, 1 and 2% solutions for instillation. The effect of mydriasis develops 30 - 60 minutes after instillation and lasts up to 2 days.
Homatropine hydrobromide
(Homatropine hydrobromide)
The drug is available in the form of 2 and 5% solutions. Instillation of homatropine hydrobromide leads to the development of mydriasis after 30 - 60 minutes. The effect lasts up to 3 days.
Scopolamine hydrobromide
(Scopolamine hydrobromidum)
Use a 0.25% solution. Instillation of scopolamine leads to the development of mydriasis after 30 - 60 minutes. The effect lasts 4 - 7 days.
Tropicamide
(Tropicamide)
A parasympatholytic that, when applied topically, blocks the response of the iris sphincter and ciliary muscle to cholinergic stimulation, which leads to pupil dilation and paralysis of the ciliary muscle. Mydriasis is short-term. When a 0.25% solution is instilled, complete cycloplegia does not occur, although at higher concentrations of the drug, clear cycloplegia may develop.
The drug is used in the form of 0.5 and 1% solutions for instillation. The effect of mydriasis develops after 20 - 40 minutes, the duration of action of tropicamide is 4 - 6 hours.
Literature:
1. PDR for Ophthalmology. 1995:2
8. Drugs of other groups
Eye drops that reduce the symptoms of allergic conjunctivitis
IN
vernal keratoconjunctivitis is chronic inflammatory disease, in which the main pathogenetic factors are immunoglobulin E (IgE) and cell-mediated reactions. Typical histological features of the disease are conjunctival infiltration of eosinophils and basophils, increased number of mast cells and hyperplasia connective tissue with increased collagen deposition. Activated eosinophils release toxic substances, in particular eosinophil cationic protein, which has a toxic effect on the corneal epithelium.
Levocabastine
(Levocabastin)
Levocabastine hydrochloride is a selective H1 receptor agonist. The drug has the ability to reduce the severity of itching associated with allergic conjunctivitis. The pathophysiological sign of the so-called seasonal allergic conjunctivitis is an analogue anaphylactic reaction type 1 hypersensitivity. In this case, an increase in the level of IgE is detected in the tear fluid. In addition, an increase in the level of histamine and eosinophil basic protein was detected in the tear fluid of patients with allergic conjunctivitis. It's obvious that effective treatment Allergic conjunctivitis is possible only after identifying the specific causative antigenic substance and stopping its effect on the eye. 
Rice. 5. Allergic conjunctivitis
H1 receptors were discovered in the conjunctiva, blockade of which by specific agents prevented the development of the vasodilatory effect of histamine and its ability to cause itching. Clinical study Levocabastine hydrochloride, conducted by R. Bischoff and M. Gerber, revealed the effectiveness of the drug in 73.8% of cases, and tolerance to the drug was satisfactory in 89% of patients. Advantage of local use antihistamines at allergic conjunctivitis that it is possible to achieve good clinical effect without developing the sedative effect inherent in systemic antihistamines. After instillation into the conjunctival cavity, a certain amount of levocabastine undergoes systemic absorption, but this amount has no therapeutic significance and on average does not exceed 1 - 2 ng in 1 ml of blood plasma.
Levocabastine hydrochloride is used in the form of a 0.05% suspension and is contraindicated only in cases of individual intolerance to this drug.
Levocabastine does not have carcinogenic properties, but a teratogenic effect is possible, so the drug should be prescribed to pregnant women only in exceptional cases.
From adverse reactions the most commonly reported sensation is a mild and transient burning sensation in the conjunctival cavity.
The usual therapeutic dose is instillation of one drop 4 times a day into the affected eye. The course of treatment can last up to 2 weeks.
Lodoxamide
(Lodoxamide)
Lodoxamide is a mast cell stabilizer and can suppress type 1 hypersensitivity reactions. The use of lodoxamide suppresses the developing increase in vascular permeability in response to IgE, as well as in antigen-induced reactions. The ability of lodoxamide to stabilize mast cell membranes has been demonstrated in in vitro experiments, in which it was found that the release of histamine in response to antigen was thereby suppressed. Thus, exposure to lodoxamide prevents the release of not only histamine, but also other mediators of mast cell inflammation (for example, slow-reacting substance of anaphylaxis), which, in particular, inhibits eosinophil chemotaxis. The exact mechanism of action of lodoksamide remains unclear, although there are reports of the ability of lodoksamide to prevent the entry of calcium ions across the membrane of mast cells when they are antigenically stimulated. In patients with vernal keratoconjunctivitis, lodoxamide significantly reduced the content of eosinophilic cationic protein in the tear fluid and suppressed the activation of eosinophils. Lodoxamide does not have concomitant vasoconstrictor, antihistamine and anti-inflammatory effects, and is also not able to inhibit cyclooxygenase. Lodoksamide is excreted from the body in the urine. Local administration of a 0.1% solution of the drug, 1 drop 4 times a day, does not lead to its appearance in therapeutically significant concentrations in the blood serum (less than 2.5 ng/ml).
Instillation of lodoxamide is indicated for the treatment of vernal keratoconjunctivitis. The drug is prescribed as a 0.1% solution, 1 to 2 drops 4 times a day into the affected eye for no more than 4 months.
A contraindication to the use of lodoxamide is hypersensitivity to this drug. Of the adverse reactions, the most significant are the rarely observed sensation of the presence of a foreign body and burning sensation, which are transient and do not interfere with long-term use of the drug. In less than 1% of cases, the formation of erosions on the cornea, the development of keratopathy, and epitheliopathy were observed.
Sodium cromoglycate
(Cromolyn sodium)
Cromolyn sodium is also an effective antiallergic drug that acts as a mast cell membrane stabilizer.
Sodium cromglycate eye drops are well tolerated by patients. Absorption of the drug through the mucous membrane of the eye is insignificant; sodium cromglycate is released from the body unchanged within several hours. Sodium cromglycate prevents degranulation of mast cells, stabilizes cell membrane and thus preventing the release of histamine and other inflammatory mediators. Thanks to this mechanism of action, the drug sodium croomglycate gives best effect for prophylactic use.
It is used in the form of a 4% solution 4 to 6 times a day in the form of instillations into the conjunctival cavity of the affected eye.
Literature:
1. Leonardi A, Abatangelo G, Cortivo R, et al. Collagen type I and III in vernal keratoconjunctivitis. Br J Ophthalmol 1995;79:482-5.
2. Leonardi A, De Paoli M, Fregona I, Violato D, et al. Fibroblast activity and collagen overproduction in VKC. Invest Ophthalmol Vis Sci 1995;36(suppl):3866.
3. Tomassini M, Magrini L. Increased serum level of eosinophil cationic protein in vernal keratoconjunctivitis. Ophthalmology 1994;101:1808-11.
4. Gareis O, Lang G, Allergic diseases of the lid, conjunctiva and cornea. Current Opinion in Ophthalmology 1993;4(4):34-40.
5. Ehlers W, Donshik P, Allergic Ocular Disorders. CLAO J 1992;2:117-24.
6. Norn M. Pollution Keratokonjunctivitis. Acta Ophthalmol (Copenh) 1992;70:269-73.
7. Bischoff P, Gerber M. Multizentrische Prufung Eines Neuen Lokalen Antihistaminikums (Levocabastin). Klin Monatsbl Augenheilkd 1992;200:354-7.
8. Leonardi A, Borghesan F, Avarello A, et al. Effect of lodoxamide and disodium cromglycate on tear eosinophil cationic protein in vernal keratoconjunctivitis. Br J Ophthalmology 1997;81:23-6.
9. Leino M, Carlson C, Kilkku O, et al. The effect of sodium cromglycate eyedrops. Acta Ophthalmol (Copenh) 1992;70:341-5.