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Clinical Pearl of the Month🐚 - Instilling Cyclo Drops

28 Apr 2019 9:18 PM | Anonymous

Cycloplegic drops have two main benefits in optometric practice. Firstly, cycloplegic is a useful tool in assessment of refractive error. Cycloplegia inhibits the accommodative power of the eye by blocking the action of the ciliary muscle, allowing the static or objective refractive error of the eye to be measured. Two main cycloplegia drugs are used in practice: atropine and Cyclopentolate. These drugs are called anticholinergic because they block the muscarinic action of acetylcholine. This action inhibits cholinergic stimulation of the iris sphincter and ciliary muscle, which results in mydriasis and cycloplegia. Secondly, as it dilates the pupil it allows for ophthalmoscope examination.

Cycloplegic retinoscopy and refraction helps determine full hyperopia in patients with accommodative esotropia and prevents overcorrection in myopic patients, making it a great tool, especially when testing children. It is also useful in prescribing correction in patients with limited cooperation during subjective refraction and amblyopic patients.

In practice, cyclopentolate hydrochloride 1% is the cycloplegic agent of choice. It has a faster onset of effect and reaches peak effect after 30-45minutes, its effect also washes out after 4-8 hours. Contradictions for cycloplegic drops is in patients with: closed-angle glaucoma, Down’s Syndrome, seizures, in pregnancy or breast feeding patients its effect is still unknown. Hypersensitivity to atropine is also not uncommon.

Here are some of our top tips for instilling eye drops in children:

  • If the situation allows, let the parents and child know that the eye drops cause a stinging sensation: doing so is important as it builds trust.

  • Show the child what the container of eye drops/ointment looks like. Put some on the back of the child's hand so he or she knows what it feels like.

  • Work as quickly and calmly as you can - this minimises the child's distress.

  • Recline the patient backwards or leaning into the chair comfortable, have them look up to the ceiling (have a picture or object for them to look at to distract them) and instill into nasal canthus. Or they can keep their eyes closed as you attempt to pull down their lower eyelid and instil it into their conjunctival sac.

  • Blinking exposes the eye to air and causes an increased stinging sensation. After the drop is in, ask child to keep their eyes closed and count to the highest number they know. Make it a silly competition. “1, 2, 3,...685,...ten billion”.

  • Praise, praise, praise! Let the child know they’ve done a great job. A little reward such as a sticker or jellybean goes a long way.

  • If your patient is nervous or afraid, often demonstrating on yourself or their parent (with a substituted lubricant) can help relax and calm them as they can see what would happen. If they are still nervous you can have them practice at home with lubricants before returning for their cycloplegic examination.

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