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      Mydriatic and Cardiovascular Effects of Phenylephrine 2.5% versus Phenylephrine 10%, Both Associated with Tropicamide 1%

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          Abstract

          Background/Aims: To evaluate and compare cardiovascular effects (blood pressure and heart rate) of phenylephrine 2.5% versus phenylephrine 10%, and compare pupil diameter before and after instillation of eyedrops. Methods: A total of 58 patients scheduled for funduscopy were dilated with either phenylephrine 2.5% and tropicamide 1% (group 0, n = 29 patients, 58 eyes) or phenylephrine 10% and tropicamide 1% (group 1, n = 29 patients, 58 eyes). Only one drop per eye of each drug was administered. In both groups, pupil diameter, blood pressure and heart rate were measured before and 40 min after eyedrop instillation. Results: We did not observe significant changes in blood pressure or heart rate. Mean pupil diameter in group 0, before the instillation of eyedrops, was 3.51 mm and, in group 1, 2.66 mm. After medication, mean values were 7.38 mm in group 0 and 7.42 mm in group 1. Mean variation was 3.87 mm in group 0 and 4.76 mm in group 1 (p < 0.001). Conclusion: Our results corroborate the finding that one single drop of either 2.5 or 10% phenylephrine is safe and, when 1% tropicamide is combined, satisfactory pupil dilation is achieved.

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          Most cited references 6

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          Drop size and initial dosing frequency problems of topically applied ophthalmic drugs.

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            Comparative pupil dilation using phenylephrine alone or in combination with tropicamide.

            A prevalence survey of actinic and other eye diseases was conducted in Nambour, Queensland, Australia, in 1992. Pupils were dilated with phenylephrine alone for cataract identification because there were concerns that patient discomfort, due to cycloplegia occurring with the usual dilating agents of tropicamide and phenylephrine, may influence future compliance in an associated intervention study. This validation study was undertaken to measure the possible underestimation of cataract prevalence in this community study, which may have occurred because of inadequate dilation from phenylephrine alone. The study design was a repeated measures experimental design. Forty-seven normal subjects participated in the study. Both eyes were tested. Pupil diameter after dilation with three drops of 10% phenylephrine alone was compared with pupil diameter after dilation with three drops of 10% phenylephrine together with three drops of 1% tropicamide. The two regimens were given to the same subjects 1 week apart. Reversal was attempted with thymoxamine hydrochloride 0.5%. Pupil diameter was assessed using a Neitz cataract camera, and accommodation reserve also was measured. Subjects' subjective appreciation of return of ocular function was assessed by a questionnaire. Repeated measures analysis of variance, paired t test, McNemar's test, and Wilcoxon signed rank test were used to analyze outcomes. Mean maximum pupil size with 10% phenylephrine and 1% tropicamide was significantly larger than pupil size after the use of 10% phenylephrine alone (F1,19 = 18.99, P = 0.0003). However, there was no significant difference between the two dilation regimens when comparing the proportion of subjects who dilated to 6 mm or more (McNemar's X(2)1 = 2.7, P > 0.1). Compared with 10% phenylephrine and 1% tropicamide, pupil diameters were significantly smaller (t46 = 16.77, P = 0.0001), and accommodation reserve greater (t46 = 4.14, P = 0.0001), 40 minutes after reversal with thymoxamine in the group dilated with 10% phenylephrine alone. Pupil dilation with 10% phenylephrine alone, if allowed at least 40 minutes to act, will be as satisfactory for the identification of cataracts in a normal population as 10% phenylephrine and 1% tropicamide and is more acceptable because of reduced problems with glare and accommodation.
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              Adverse systemic effects from pledgets of topical ocular phenylephrine 10%.

              To report 11 cases of adverse systemic reactions to topical ocular application of phenylephrine 10% in pledget form and to discourage this method of treatment for hemostasis in laser assisted in-situ keratomileusis (LASIK) surgery and other ophthalmic uses.
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                Author and article information

                Journal
                ORE
                Ophthalmic Res
                10.1159/issn.0030-3747
                Ophthalmic Research
                S. Karger AG
                0030-3747
                1423-0259
                2009
                September 2009
                27 May 2009
                : 42
                : 2
                : 87-89
                Affiliations
                aFederal University of the State of Rio de Janeiro, UNIRIO, Rio de Janeiro, Brazil; bThe Henry C. Witelson Ocular Pathology Laboratory, McGill University, Montreal, Que., Canada; cFederal University of Sao Paulo, Sao Paulo, Brazil
                Article
                220601 Ophthalmic Res 2009;42:87–89
                10.1159/000220601
                19478547
                © 2009 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 1, References: 9, Pages: 3
                Categories
                Short Communication

                Vision sciences, Ophthalmology & Optometry, Pathology

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