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Flashcards in Cyclopegics Deck (112):
1

what is the primary purpose for using cycloplegics

temporary paralysis of accommodation

2

why can a hyperopic patients vision fluctuate

due to accommodation

3

list 3 optometric reasons why cycloplegics are used

- assessment of refractive error (latent hyperopia), as child can use accommodation to focus during sight test
- penalisation
- adaptation to spectacles (rare)

4

list 3 other ophthalmological uses of cycloplegics in addition to optometric reasons

- anterior uveitis (to prevent posterior synaechiae)
- corneal abrasion
- amblyopia - may blur the good eye if could is non-compliant to patching

5

list the 2 optometric indications for using cycloplegics from H and S, from symptoms

- asthenopia
- reading difficulties

6

list the optometric indications for using cycloplegics from H and S, from history

manifest deviations

7

list the 2 optometric indications for using cycloplegics from H and S, from family history

- refractive error at an early age
- manifest deviations

8

list the 2 optometric indications for using cycloplegics from clinical tests, from finding a binocular vision anomaly

- manifest eso deviation
- sometimes if latent deviation

9

list the 2 optometric indications for using cycloplegics from clinical tests, following a fluctuating ret

- if theres a large different between subjective and objective
- poor fixation

10

why will you find your ret results fluctuating on a child

because the child is accommodating and looking at something closer i.e. the ret, so the rx becomes more myopic than it is supposed to be

11

apart from binocular vision analogies and fluctuating ret, when else will you need to use cycloplegics on a px, from findings in your clinical tests

- accommodative anomalies
- if visual acuity is reduced

12

list the 6 ideal properties of a cycloplegic

- rapid onset
- adequate depth of cycloplegia (not much residual accommodation)
- adequate duration
- no stinging
- no mydriasis (but it is a side effect)
- no toxic effects, local or systemic

13

name an unnatural condition which may occur after cycloplegic installation

pupils can change shape

14

what occurs initially after instillation of cycloplegics, prior to cycloplegia and why

mydriasis
because the iris is located anteriorly and close to the ciliary muscle

15

list the 3 effects of cycloplegics

- initially mydriasis
- cycloplegia
- reduced tear secretion

16

what occurs within the eye in order to cause cycloplegia

relaxation of the ciliary muscle, increasing tension on suspensory ligaments

17

list the 3 things that muscarinic agonists such as cycloplegics affect

- lacrimal gland
- iris sphincter muscle
- ciliary body

18

list the 5 pieces of advice you will give to a parent before instilling cycloplegics into their child's eye

- explain the need to use
- onset
- duration
- expected side effects
- caution

19

what advice will you give to a child before instilling cycloplegics into their eye

- explain that they might feel the drop on the eye
- use one drop of proxymetacaine first?

20

why may you want to use proxymetacaine before instilling a cycloplegic

- child will not feel the stinging sensation
- it helps the cyclo go through as the cornea is more permeable

21

what must you do if consent for cycloplegics is denied for the child by the parent/guardian

- explain the advantages and disadvantages
- note refusal on the record
- if concern for the child is great then refer to the GP

22

what must you do is consent or cycloplegics is denied by the child themselves

- Gillick competent (if the child is sure about their decision even though they're below the age of 16)
- record all discussions on notes
- if concern for the child is great, then refer to the GP

23

what 2 things may be a helpful way of instilling cycloplegic drops

the patient lying down or sometimes drop onto the eyelashes

24

which 2 ways can you check for cycloplegia

- measure accommodation
- check ret reflex

25

what sign does not indicate that cycloplegia has been achieved and why

mydriasis
as the rate that the pupil dilates and the rate of cycloplegia is different

26

why may you ask the px to fixate upon the ret light during cycloplegic retinoscopy

to ensure that retinoscopy is conducted upon axis

27

what is there no need to do when carrying out cycloplegic retinoscopy (which you will usually do normally)

no need to fog the other eye

28

when will you occlude one eye when carrying out cycloplegic retinoscopy

if the child has strabismus, in order to align the other eye

29

what must you observe whilst doing cycloplegic retinoscopy and what must you ignore

observe central movement
ignore movement in the periphery

30

which types of aberration are more common during cycloplegic retinoscopy and what risks do they cause

positive aberrations more common
this makes the peripheral area more myopic and causes a risk of over prescribing minus

31

which types of aberration is more rare during cycloplegic retinoscopy and what risks do they cause

negative aberrations more rare
this makes the peripheral area more hyperopic and causes a risk of over prescribing positive

32

list the 4 types of cycloplegics and their available doses

- atropine 1%
- homatropine 1%
- cyclopentolate 0.5% and 1%
- tropicamide 1%

33

which 2 cycloplegic drugs are additional supply or independent prescriber status

atropine and homatropine

34

which cycloplegic is the weakest drug and which group of patients are they only effective in

tropicamide 1% only effective in adults

35

which cycloplegic is the most commonly used

cyclopentolate

36

what type of compound is atropine sulphate and where is it extracted from

a naturally occurring compound extracted from "belladonna" deadly nightshade

37

what type of agent is atropine sulphate

toxic

38

what was atropine sulphate the first of

first muscarine antagonist used in medicine

39

which category of medicine is atropine sulphate

POM
for use and supply by additional supply optometrists
used and prescribed by independent prescribing optometrists

40

what doses is atropine sulphate eye drops available in

- 0.5%
- 1%

41

what dose is atropine sulphate eye ointment available in

1% atropine sulphate (non-proprietary)

42

how much of atropine sulphate can be enough to kill a child

a 3ml tube of ointment

43

what dose is atropine sulphate minims available in

1% atropine sulphate Bausch and Lomb

44

which 3 forms is atropine sulphate available in

- eye drops
- eye ointment
- minims

45

what degrees must you store atropine sulphate below

25 degrees celsius and protect from light

46

what dose of atropine eye drops and for how many days prior to refraction must an adult or child > 3 months take

1 drop of 1% twice per day for 1-3 days before refraction

47

what dose of atropine ointment and for how many days prior to refraction must an adult or child > 3 months take

2 times a day for 1-3 days before refraction
give this to the parent with a leaflet

48

what must you ask parents who have received atropine sulphate ointment to do on day of refraction examination

to return the unused ointment to practice

49

when does mydriasis commence after instilling 1 drop or 1% of atropine

in 10-15 mins

50

when is maximal mydriasis achieved after instilling 1 drop or 1% of atropine

30-40 mins

51

when does mydriasis recover after instilling 1 drop or 1% of atropine

in 3-7 days

52

when does mydriasis recover after instilling 3x of atropine twice daily

after 10-14 days

53

when does cycloplegia commence after instilling 1 drop or 1% of atropine

in 30 mins

54

when is maximal cycloplegia achieved after instilling 1 drop or 1% of atropine

in 1-3 hours, not complete

55

when does cycloplegia recover after instilling 1 drop or 1% of atropine

in 3-7 days

56

when does cycloplegia recover after instilling 3x of atropine twice daily

after 7-10 days

57

when does adequate near vision recover after instilling 3x of atropine twice daily

after 4-5 days

58

what tones does the ciliary muscle have

a dependent and an independent tone

59

what needs to be made for the dependent tone after atropine instillation and how

an allowance - where the spherical power only needs to be adjusted in the less positive direction

60

what amount of allowance needs to be made for dependent tone following atropine for low myopes and hyperopes (

-1.00DS

61

what amount of allowance needs to be made for dependent tone following atropine for moderate and high myopes

0.00DS

62

which drugs is allowance for dependent tone not applicable

cyclopentolate and tropicamide

63

why has atropine dependent tonus allowance been abolished

because theres a risk of over plussing the patient

64

list 3 possible contraindications to atropine

- a known allergy to atropine or component of the preparation
- narrow angles?
in children?

65

list the 7 types of people who need to be cautioned when using atropine

- children

66

why must you take caution with a child

it can cause amblyopia from stimulus deprivation

67

why must you take caution with atropine on someone who has a intermittent manifest deviation

as the accommodation is paralysed for so long, deviation may become permanent

68

list 4 immediate ocular side effects that can occur when taking atropine

- transient stinging
- blurring
- photophobia
- raised IOP?

69

list 4 ocular side effects that can occur when using atropine repeatedly

- hyperaemia
- oedema
- itching, irritation
- follicular conjunctivitis

70

what are the 3 general body side effects of atropine

- toxic effects
- tachycardia
- death from respiratory depression

71

list the 4 different toxic effects atropine has on the body

- dry as a bone: dry mouth and skin due to decreased secretion of salivary and sweat glands

- red as a beetroot: flushing, increased body temperature, as cannot cool body by sweating

- blind as a bat: cycloplegia

- mad as a hatter: CNS effects - ataxia, hallucinations, confusion, difficulty in speaking

72

which type of patients is most likely to die from respiratory depression as a side effect of taking atropine

children, who take a 3 gram tube of atropine
can be fatal to small children who ingest it

73

what is an additional use of atropine, and how is it used

used to treat amblyopia

- instilled into better eye
- prevents accommodation
- used when child will not tolerate patching or used as a first choice
- excellent results

74

what is the full name for cyclopentolate

cyclopentolate hydrochloride

75

what type of compound is cyclopentolate

synthetic drug

76

what dose of cyclopentolate is more useful as a mydriatic

0.5%

77

what type of medicine is cyclopentolate

POM for use and supply by all optometrists

78

what doses is cyclopentolate multi use eye drops available in and what are they called

- 0.5%
- 1.0%
called mydrilate (intrapharm)

79

at what temperature must cyclopentolate multi use eye drops be stored

between 2-8 degrees celsius

80

what doses is cyclopentolate minims available in

- 0.5%
- 1%

81

at what temperature must cyclopentolate minims be stored

below 25 degrees celsius and protect from light

82

what forms is cyclopentolate available in

- eye drops
- minims

83

what dose of cyclopentolate is used on children up to 12 years old

1%

84

what dose of cyclopentolate is used if iris pigmentation is light

0.5%

85

after how long does cycloplegia commence from cyclopentolate

after a few minutes

86

after how long is maximal cycloplegia achieved with cyclopentolate

30-60 minutes

87

after how long is maximal mydriasis achieved with cyclopentolate

30-60 minutes

88

after how long is recovery from cycloplegia with cyclopentolate

24-48 hours

89

how much of residual accommodation is there with cyclopentolate

1.50D or less

90

what amount of rx will you give after using cyclopentolate

always give full rx found

91

at what 2 exceptions will you not give the full rx following a cycloplegic refraction using cyclopentolate

- hyperopia and exo deviation
- myopia and eso deviation

92

what are the 6 types of people who have to use cyclopentolate with caution

- young children
- debilitated patients
- elderly
- avoid over dosage in darkly pigmented eyes
- pregnancy and lactation: unknown use only if risk to mother outweighs risk to foetus
- hallucinations and CNS effects reported with concentrations (a marked risk only with over dose)

93

list the 5 immediate ocular side effects from cyclopentolate

- transient stinging
- transient blurring
- photophobia (due to mydriasis)
- raised IOP - only in older px
- conjunctival hyperaemia and oedema

94

list 4 ocular side effects of cyclopentolate after prolonged administration

- irritation
- hyperaemia
- oedema
- conjunctivitis

95

list the 7 general body side effects from cyclopentolate

- dose related in children
- CNS effects
- dry mouth
- flushing
- tachycardia
- urinary symptoms
- GI symptoms

similar to atropine but at a much lower scale

96

what is an additional use of cyclopentolate, and how is it used

adaptation to spectacles as patient won't be accommodating through new spectacles

- children almost always adapt well to hyperopic prescription, so is used on children who have myopic prescriptions

- use 1% cyclopentolate daily for 2/52 weeks
- accommodation is abolished
- clear vision is only obtained via spectacle wear
- the child then usually accepts the spectacle wear

97

what is another 3 additional uses to cyclopentolate other than adaptation to spectacles

- mydriasis
- for anterior and posterior uveitis and posterior synechiae breakdown
- for alleviation of ciliary spasm

98

how is cyclopentolate used to treat anterior and posterior uveitis and posterior synechiae breakdown

1-2 drops of 1% cyclopentolate is instilled every 6-8 hours (only used my ophthalmologist in hospital)

99

how is cyclopentolate used for alleviation of ciliary spasm

1 drop is 1% cyclopentolate used 2-3 times a day

100

what is the full name for homatropine

homatropine hydrobromide

101

what category of medicine is homatropine

POM
additional supply or independent prescriber

102

what for is homatropine available in

1% multi dose containers (non-proprietary)

103

at what temperature must homatropine be stored at

below 25 degrees celsius and protect from light

104

after how long is mydriasis achieved with homatropine

30-40 minutes

105

after how long is recovery of mydriasis achieved with homatropine

24-48 hours

106

what is the full name for tropicamide

tropicamide hydrochloride

107

what 2 things is the degree of cycloplegia dependent upon with tropicamde

- age
- iris pigmentation

108

when is mydriasis used for cycloplegia in relation to age

it is only indicated for cycloplegic refraction in older patients

109

after using 2 drops of 1% tropicamide, when does mydriasis occur after

15 minutes (quicker than cyclopentolate)

110

after using 2 drops of 1% tropicamide, when does mydriasis recover after

8-9 hours

111

after using 2 drops of 1% tropicamide, when does maximal cycloplegia occur after

30 minutes

112

after using 2 drops of 1% tropicamide, when does cycloplegia recover after

6 hours