A quasi-experimental study to assess the effect of a local anesthetic proparacaine on tropicamide-induced pupillary dilation
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20150046Keywords:
Proparacaine, Pupillary dilation, Tropicamide, Clinically effective diameterAbstract
Background: Dilating the pupil is one of the most commonly practiced methods among ophthalmologists to examine the eye especially the posterior segment of the eye. Here we conducted a study to know the clinical effect of proparacaine, a local anesthetic, on tropicamide-induced pupillary dilation.
Methods: A Quasi-experimental study was conducted on 57 subjects aged between 20 and 70 years. Study was done over a period of 3 months (February 14 - April 14) at a tertiary health care center in Bagalkot after obtaining institutional ethical committee clearance. Proparacaine was instilled in one eye (right eye) before instilling tropicamide and the other eye with a placebo (normal saline). Pupil diameter was measured using a pupillary gauge at 0, 15, and 30 mins. Results were analyzed using unpaired Student’s t-test.
Results: The mean clinically efficient pupillary diameter at the end of 15 mins in proparacaine instilled eye was 5.56±0.5 and in control eye was 5.25±0.45 mm with t value 8.13 (p<0.001) which was statistically significant. And at the end of 30 mins pupillary diameter in the study group was 7.96±0.43 mm and in the control group was 7.83±0.43 mm with t value of 4.115 (p<0.001) which was also statistically significant.
Conclusions: Therefore, we do recommend the use of proparacaine before instilling tropicamide for faster pupillary dilation.
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References
Phillips CI. Dilate the pupil and see the fundus. Br Med J (Clin Res Ed). 1984;288(6433):1779-80.
Whitmer L. To see or not to see: routine pupillary dilation. J Am Optom Assoc. 1989;60(7):496-500.
Barlett JR, Siderov J. Routine dilatation: appropriate choice of technique. Clin Exp Optom. 1995;78:38-9.
Steinmann WC, Millstein ME, Sinclair SH. Pupillary dilation with tropicamide 1% for funduscopic screening. A study of duration of action. Ann Intern Med. 1987;107(2):181-4.
Talley DK, Bartlett JD. Topical and regional anesthesia. In: Bartlett JD, editor. Clinical Ocular Pharmacology. 3rd Edition. Boston: Butterworth-Heinemann; 1995: 463-78.
Bartlett JD. Dilation of the pupil. In: Bartlett JD, Jaanus SD, editors. Clinical Ocular Pharmacology. 3rd Edition. Boston: Butterworth-heinemann; 1995: 479-502.
Isenberg SW. The Eye in Infancy. 2nd Edition. St Louis: Mosby; 1994.
Forman AR. A new low-concentration preparation for mydriasis and cycloplegia. Ophthalmology. 1980;87(3):213-5.
Lyle WM, Bobier WR. Effects of topical anesthetics on phenylephrine-induced mydriasis. Am J Optom Physiol Opt. 1977;54(5):276-81.
Mordi JA, Lyle WM, Mousa GY. Does prior instillation of a topical anesthetic enhance the effect of tropicamide? Am J Optom Physiol Opt. 1986;63(4):290-3.
Bryant JA. Local and topical anesthetics in ophthalmology. Surv Ophthalmol. 1969;13(5):263-83.
Apt L, Henrick A. Pupillary dilatation with single eye drop mydriatic combinations. Am J Ophthalmol. 1980;89(4):553-9.
Jauregui MJ, Polse KA. Mydriatic effect using phenylephrine and proparacaine. Am J Optom Physiol Opt. 1974;51(8):545-9.
Kubo DJ, Wing TW, Polse KA, Jauregui MJ. Mydriatic effects using low concentrations of phenylephrine hydrochloride. J Am Optom Assoc. 1975;46(8):817-22.
Ghose S, Garodia VK, Sachdev MS, Kumar H, Biswas NR, Pandey RM. Evaluation of potentiating effect of a drop of lignocaine on tropicamide-induced mydriasis. Invest Ophthalmol Vis Sci. 2001;42(7):1581-5.
Pollack SL, Hunt JS, Polse KA. Dose-response effects of tropicamide HCl. Am J Optom Physiol Opt. 1981;58(5):361-6.
Ogun OA, Oliver JW, Ashaye AO, Ajayi BG. Evaluating the potentiating effect of amethocaine on tropicamide-induced mydriasis in darkly pigmented irides, using infrared pupillometry. Ophthalmol Eye Dis. 2014;6:13-9.
Emiru VP. Response to mydriatics in the African. Br J Ophthalmol. 1971;55(8):538-43.
Chen KK, Poth EJ. Racial differences as illustrated by the mydriatic action of cocaine, euphthalmine and ephedrine. J Pharmacol Exp Ther. 1929;36:429-45.
Brewitt H, Bonatz E, Honegger H. Morphological changes of the corneal epithelium after application of topical anaesthetic ointments. Ophthalmologica. 1980;180(4):198-206.
Richardson RW. Comparing the mydriatic effect of tropicamide with respect to iris pigmentation. J Am Optom Assoc. 1982;53(11):885-7.
Zauberman H, Neuman E. Tropicamide – a mydriatic cycloplegic in a West African eye clinic. Cent Afr J Med. 1970;16(1):8-11.
