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YR 3 Eye Disease and Therapeutics > Cycloplegics > Flashcards

Cycloplegics Flashcards

1
Q

why use cycloplegics

A

optometric uses

  • assessment of refractive error - latent hyperope - accommodative muscle are used to increase the eye focusing power
  • penalisation - instead of occlusion
  • adaptation to specs (rare) - vision clear only with gls

additional opthalmological uses

  • ant uveitis - dilating pupil and alleviating ciliary spasm
  • corneal abrasion - alleviate ciliary spasm
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2
Q

cycloplegics - optometric indications from h&s

A

symptoms - asthenopia, reading diff
history - mainfest deviations
family history - refractive error at an early age, manifest deviations

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3
Q

cycloplegics - optometric indications from clinical test s

A

binocular vision anomaly - manifest eso deviation, sometimes if latent deviation
fluctuating ret - large diff bet subjective and objective, or poor fixation
accommodative anomalies
visual acuity reduced

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4
Q

cycloplegic - effects

A

initially mydriasis

  • iris located anteriorly to ciliary muscle
  • unneccesary side effect

cycloplegia

  • paralysis of ciliary muscle, resulting in loss of accom
  • because of the paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on near objects
  • reduced tear secretion - px may complain of dry eye after instillation
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5
Q

what do antimuscarinic agents affect

A
  • lacrimal gland
  • iris sphincter muscle
  • ciliary body
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6
Q

advice before instillation

A

for parent guardian

  • explain need to use
  • onset
  • duration
  • expected side effects
  • caution

for child

  • explain might feel drop on eye
  • 1 drop of proxymetacaine first? - RCO guidelines
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7
Q

what happens if consent is denied

A

parent/guardian

  • explain advantages/disadvantages
  • note refusal on record
  • if concern for child great refer to GP

child

  • Gillick competent - whether child can consent themselves to procedure
  • record all discussions on notes
  • if concern for child great refer to gp
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8
Q

instiling drops and how to check for cyclo

A

instillation - lying down may help, sometimes drop onto eyelashes can help
checking for cycloplegia - measure accom,

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9
Q

cycloplegic retinoscopy

A
  • sit younger child on px knee
  • can use px to fixate upon light - ensures ret is conducted upon axis
  • no need to fog other eye
  • can try using lens rack
  • observe central movement - 3-4mm
  • ignore movement in periphery
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10
Q

cycloplegic drugs - strong to weak

A

atropine 1% - additional supply or independent prescriber status, associated with numerous side effects
cyclopentolate 0.5 and 1% - most commonly used
homatropine 1% - additional supply of independent prescriber status
tropicamide 1% - weakest drug, only effective in adults, used mainly as a mydriatic

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11
Q

atropine preparations

A
  • atropine sulphate: eye drops (non proprietary) - 0.5 and 1% atropine sulphate
  • atropine sulphate: eye ointment - 1% atropine sulphate, non proprietary
  • minims - 1% atropine sulphate (B&L) - store below 25 degrees and protect from light
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12
Q

atropine dose

A

adults and children > 3mths
eye drops - 1 drop (1%) twice per day for 1-3 days before refraction
ointment - 2 times a day for 1-3 days before refraction
- the ointment is preferable as systemic toxic effects reduced and prolonged contact with eye

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13
Q

atropine - timing after instilling 1 drop of 1%

A

mydriasis

  • commences in 10-15 mins
  • maximal in 30-40mins
  • recovers in 3-7 days

cycloplegia

  • commences in 30 mins
  • maximal at 1-3 hrs
  • recovers in 3-7 days
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14
Q

atropine - timing after 3x twice daily instillations

A

mydriasis
- recovers after 10-14 days

cycloplegia

  • recovers after 7-10 days
  • adequate near vision recovers after 4-5 days
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15
Q

atropine - tonus allowance

A
  • ciliary muscle has depndent and independent tone
  • allowance needs to be madefor dependent tone - spherical power only needs to be adjusted in less positive direction
  • -1.00DS for low myopes and hyperopes
  • 0DS for mod and high myopes
  • not applicable to cyclopentolate and tropicamide
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16
Q

atropine - cautions and contraindications

A

contraindications
- known allergy to atropine or component of the preparation. Narrow angles? in children?

cautions

  • children <3 mths, elderly or debilitated, downs syndrome
  • children with brain damage
  • hypersensitivity
  • soft contact lens
  • multi dose containers containing benzalkonium chloride - do not use if lenses worn
  • intermittent manifest deviations

pregnancy and lactation interactions

17
Q

ocular side effects of atropine sulphate

A
  • transient stinging
  • blurring
  • photophobia
  • raised iop?
  • repeated use leads to hyperaemia, oedema, itching and irritation, follicular conjunctivitis
18
Q

general body side effects of atropine sulphate

A

toxic effects

  • dry as a bone: dry mouth and skin
  • red as a beetroot: flushing, increased body temp
  • blind as a bat: cycloplegia
  • mad as a hatter: cns effects - ataxia, hallucinations, confusion, diff in speaking
  • tachycardia
  • death from resp depression - more likely in children, 3 gram tube can be fatal to a small child
19
Q

atropine - additional uses

A

atropine penalisation

  • used to treat amblyopia
  • instilled into better eye
  • prevents accom
  • used when child will not tolerate patching/ first choice
  • excellent results
20
Q

cyclopentolate hydrochloride

A
  • commonly used cycloplegia
  • stings
  • synthetic drug
  • not commonly used as a mydriatic by optoms - 0.5% more useful as a mydriatic
21
Q

cyclopentolate preparations

A

POM for use and supply by all optoms
Mydrilate: eye drops
- 0.5 and 1% cyclopentolate HCL, stored bet 2-8 degrees celsius

Minims: 0.5 and 1% cyclopentolate HCL, store below 25 degrees celsius, protect from light

22
Q

cyclopentolate timing

A

cycloplegia
- commences after a few mins, maximal in 30-60 mins, recovery 4-12hrs

mydriasis
- 30 mins, recovery 24-48hrs, residual accom <1.50D, time scale variable

23
Q

cyclopentolate tonus allowance

A
  • no tonus allowance made
  • almost always give full rx found
    exception:
  • hyperopia and exo deviation
  • myopia and eso deviation
24
Q

cyclopentolate cautions

A
  • young children
  • debilitated pxs
  • elderly
  • avoid over dosage in darkly pigmented eyes - compressing the lacrimal sac for 2-3 mins after instillation of the drops
  • pregnancy and lactation - unknown use only if risk to mother outweighs risk to foetus
  • ## hallucinations and CNS ffects reported with concentrations
25
Q

cyclopentolate ocular side effects

A
  • transient stinging and blurring
  • photophobia
  • raise iop
  • conj hyperaemia and oedema
  • after prolonged administration: irritation, hyperaemia, oedema, conjunctivitis
26
Q

cyclopentolate general body side effects

A

dose related - children

  • cns effects
  • dry mouth
  • flushing
  • tachycardia
  • urinary symptoms
  • GI symptoms
27
Q

cyclopentolate - additional uses

A
  • adaptation to specs
  • children almost always adapt well to hyperopic rx
    use 1% cyclopentolate daily for 2/52
  • accom abolished
  • clear vision only obtained via specs wear
  • child usually then accepts spec wear
  • mydriasis commences after 10 mins, maximal in 30-60 mins, duration 24hrs
  • for ant and post uveitis and post synechiae breakdown: 1-2 drops (1%) are instilled every 8 hrs

for alleviation of ciliary spasm: 1 drop (1%) 2-3 times a day

28
Q

homatropine hydrobromide

A

POM - additional supply or independent prescriber

  • 1% multi dose containers (non proprietary), store below 25 degrees, protect from light
  • used for dilating pupil in ant uveitis
  • alleviation of ciliary spasm following corneal abrasion
  • mydriasis 30-40 mins
  • recovery 24-48 hrs
29
Q

tropicamide hydrochloride

A

degree of cycloplegia dependent on:

  • age - only indicated for cycloplegic refracton in older px in late teens or older, 1% strength only suitable
  • iris pigmentation - degree of cycloplegia dependent upon pigmentation

effects after instillation of 2 drops of 1% solution

  • mydriasis after 15 mins, recovery 8-9hrs
  • cycloplegia maximal after 20 mins, recovery 6 hrs

YR 3 Eye Disease and Therapeutics (9 decks)

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