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Source publication
Purpose:
A prospective study to evaluate the adverse cardiovascular effects of topical phenylephrine and tropicamide used for pupillary mydriasis before cataract surgery.
Methods:
A total of 517 consecutive eyes in 517 patients subjected to routine 0.8% tropicamide and 5% phenylephrine eye drops before undergoing cataract surgery (phacoemulsific...
Contexts in source publication
Context 1
... P < 0.05 was considered statistically significant results Taking into consideration age, gender, height, and weight, the demographic data were found to be normally distributed using the Shapiro-Wilks W-test. The demographic data from the patients are summarized in Table 1. ...Similar publications
Bilateral cataracts were diagnosed in two rescued juvenile, immature loggerhead sea turtles (Caretta caretta), weighing 1.65 and 1.7 kg. Both animals showed vision impairment and difficulty in feeding without assistance. In fact, they did not notice the presence of the food in the tank unless it was brought close to touching the mouth. Ocular ultra...
Background
Collyrium administration is a common procedure in the neonatal ward, both in preterm and at term babies. Various molecules are used to induce mydriasis and cycloplegia: among them, phenylephrine and tropicamide are the most popular, and their administration is generally considered safe.
Case presentation
A 35 + 2 weeks-old, 2510 g, well...
Citations
... -Phenylephrine [7], a selective sympathetic mimetic receptor agonist 1, available in different formulations (2.5% and 10%) as mydriatic eye drops. -Tropicamide [7], a muscarinic antagonist available in various formulations (0.5% and 1%) which is used in the ophthalmic field for cycloplegia and mydriasis. ...
... -Phenylephrine [7], a selective sympathetic mimetic receptor agonist 1, available in different formulations (2.5% and 10%) as mydriatic eye drops. -Tropicamide [7], a muscarinic antagonist available in various formulations (0.5% and 1%) which is used in the ophthalmic field for cycloplegia and mydriasis. ...
The purpose of this study is to evaluate choroidal thickness (ChT) at the subfoveal and peripheral level after the instillation of 0.5% tropicamide + 10% phenylephrine 9 hydrochloride eye drops by using OCT scans in enhanced depth image (EDI) mode. In total, 53 patients (30 males and 23 females) were involved, and the mean age was 25.62 ± 2.41 (age range: 23–36). The dominant eye was treated with tropicamide + phenylephrine (Visumidriatic Fenil 100 mg/mL + 5 mg/mL, Visufarma) while the nondominant eye was used as the control. An OCT analysis was performed on both eyes before and 30 min after the instillation of a drop of mydriatic in the dominant eye. The ChT was measured by using the OCT software measurement tool (Spectralis; Heidelberg Engineering; Heidelberg, Germany, version 6.0). The results showed a statistically significant ChT decrease (p = 0.009) in the temporal sector after the treatment with tropicamide + phenylephrine. In the subfoveal and nasal sectors, no statistically significant ChT changes were detected (p = 0.94; p = 0.85) following the administration of the mydriatic eye drops. The ChT thinning in the temporal sector following the instillation of the tropicamide + phenylephrine eye drops suggests that in the case of ChT studies, mydriatic administration should be avoided.
... In addition, multiple and frequent instillations of drops should be avoided to prevent any cumulative dosage effect in the blood due to systemic absorption. 1 We herein report the case of a woman who developed cardiac toxicity after an intramuscular injection of 2.5 mL of an ophthalmic solution containing tropicamide and phenylephrine (Visumidriatic Phenylephrine ® 100 mg/mL + 5 mg/mL, Visufarma S.p.A., Italy). To the best of our knowledge, this is the first reported case of cardiotoxicity induced by an ophthalmic formulation of tropicamide and phenylephrine used intramuscularly for voluntary purposes. ...
We report the case of a 40-year-old woman with a history of an opioid use disorder who presented to our emergency department complaining of palpitations, chest pain, and headache after the intramuscular injection of an ophthalmic solution containing tropicamide and phenylephrine (Visumidriatic Phenylephrine® 100 mg/mL + 5 mg/mL, Visufarma S.p.A., Italy) a few hours earlier for a voluntary purpose. She developed cardiac toxicity with hypertension, tachycardia, and high levels of high-sensitivity cardiac troponin I, which required continuous cardiac monitoring for 48 hours with complete resolution of the cardiac damage without complications. Based on the current literature, this is the first reported case of cardiotoxicity induced by an ophthalmic solution of tropicamide and phenylephrine used intramuscularly for voluntary purposes.
... The higher concentration is typically avoided due to the risk of causing adverse systemic effects including tachycardia, bradycardia, hypertension in patients with pre-existing heart conditions, stroke and arrhythmia. 23,[35][36][37][38] Phenylephrine is often used in combination with tropicamide to achieve maximum mydriasis. ...
Pharmacologic mydriasis, or pupillary dilation, is achieved using various agents, and is an important component of a comprehensive eye examination. Of the medications available to achieve mydriasis, the most favourable are those with a rapid onset and a low risk of causing side effects. The current standard of care is to administer multiple drops of different medications to achieve mydriasis. However, a number of innovations in the field are addressing this shortcoming. Fixed-combination eyedrop therapy has been suggested as a more efficient method, with the potential to cause fewer side effects. Additionally, novel drug delivery devices have been devised to further improve efficiency and decrease waste by delivering smaller volume drops with greater precision. Two devices of current interest are the Nanodropper (Nanodropper, Inc., Rochester, MN, USA) and Optejet® (MydCombi™; Eyenovia, Inc., New York, NY, USA). Recent studies of these devices have shown their ability to achieve similar levels of mydriasis as conventional medications without additional side effects. Furthermore, the Optejet has shown in two phase III trials that fixed-combination therapy is able to achieve greater pupil dilation compared with the current standard. This review provides an overview of pharmacologic dilation and reviews these emerging technologies.
