Panuveitis
Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen in Practical Uveitis, 2017
Treatment wise the patient is started on topical Maxidex (dexamethasone 0.1%) steroid drops to be given at hourly intervals throughout the day and a cycloplegic in the form of cyclopentolate 1% one drop twice a day. Topical antibiotics really have no role in the treatment of typical endophthalmitis, though exceptions include trabeculectomy-related ‘blebitis’ with pus in a thin-walled bleb or a corneal suture related abscess that has progressed to endophthalmitis. Topical antibiotics are occasionally started four times a day (qds) as some sort of post-tap infection prophylaxis but there is no real need. Traditionally oral antibiotics are also started but this was more to benefit the doctor that everything was being done rather than conferring any actual useful benefit to the patient. Ciprofloxacin 750 mg twice daily (bd) is the most common oral antibiotic. An alternative is oral Moxifloxacin 400 mg od, but this must not be used in children, or anyone with a history of liver disease. Likewise most specialists start oral prednisolone at this point on the basis that it calms the inflammation faster although again in practice while this may be so there is no real effect on the end visual acuity. A starting dose of prednisolone 60 mg once daily (od) can be commenced within 24 hours post-tap, as long as fungal endophthalmitis is not suspected.
My Baby Has a White Pupil in This Photograph and/or Has a Squint
Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen in Practical Emergency Ophthalmology Handbook, 2019
A dilated examination is essential in all children presenting for the first time to an emergency department, especially if they have an abnormality of ocular alignment or abnormal pupil reflexes. If the child is younger than 6 months then cyclopentolate 0.5% ±phenylephrine 2.5% can be used and will provide adequate cycloplegia. If they are older than 6 months then cyclopentolate 1% can be used, or atropine 1% if they have particularly dark irises. Assess the red reflex for symmetry and uniformity. A nasal mass for example may have a normal red reflex if the child is looking to the opposite side. When assessing the phakic lens, always use a portable slit lamp where possible as lens opacities are not always necessarily evident with a red reflex check alone. The retinoscope is a useful tool as it often gives a clear red reflex even if the ophthalmoscope doesn't. Fundal examination is again essential in all cases. If you can't see or are not confident then don't be afraid to ask for a senior opinion, but practice makes perfect. A B-scan is always useful in the un-cooperative child with a difficult fundal view.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Anton C. de Groot in Monographs in Contact Allergy, 2021
Cyclopentolate is a parasympatholytic anticholinergic drug. Administered in the eye, cyclopentolate blocks the acetylcholine receptor in the sphincter muscle of the iris and the ciliary muscle, thereby preventing contraction. This produces mydriasis (excessive dilation of the pupil) and cycloplegia (paralysis of the ciliary muscle of the eye), which facilitates ophthalmic diagnostic procedures. Cyclopentolate acts more quickly than atropine and has a shorter duration of action (1). In pharmaceutical products, cyclopentolate is employed as cyclopentolate hydrochloride (CAS number 5870-29-1, EC number 227-521-8, molecular formula C17H26ClNO3) (1).
Should “Retro-ocular Pain, Photophobia and Visual Acuity Loss” Be Recognised as a Distinct Entity? The ROPPVAL Syndrome
Published in Neuro-Ophthalmology, 2021
Francesco Pellegrini, Erika Mandarà, Daniele Brocca
Photophobia is defined as a painful sensation to light exposure. Recently, a novel population of retinal neurons, intrinsically photosensitive retinal ganglion cells (IPRGCs), have been identified as photophobia transducers in the eye.13 Notably, these IPRGCs project onto trigeminal neurons14 and pain nuclei in the thalamus,15,16 which are also involved in migraine pathogenesis. We believe that “stimuli”, like those involved in migraine, may trigger the trigeminal nerve fibres which collect painful light sensations from the eye when activated by IPRGCs. We believe that the ciliary ganglia located in orbital-fat behind the globe may play a major role in determining this stereotyped syndrome, because of the relief of symptoms when amitriptyline or cyclopentolate drops are administered. We can speculate that activated trigeminal pain-sensing fibres and light-activated fibres may affect parasympathetic neurons and/or vice versa. Cyclopentolate is an anticholinergic drug, thus paralyses the iris sphincter constrictor and ciliary body muscles. Cycloplegia is commonly used in ophthalmology to reduce inflammation and pain due to different ocular conditions such as iritis where the ciliary body over-contraction is the main cause of pain.
Practical use and prescription of ocular medications in children and infants
Published in Clinical and Experimental Optometry, 2021
Ann L Webber, Phillipa Sharwood
In healthy children, one drop of 0.5% cyclopentolate is recommended for use in children aged less than 12 months of age, and 1% for older children for routine comprehensive refractive and ocular health examination. Typically, one drop of 1% cyclopentolate is preceded by one drop of topical anaesthetic (0.5% proxymetacine hydrocholoride or oxybuprocaine), with refractive error measure carried out 30 min after drop instillation once cycloplegic. Iris colour and ethnicity are reported to influence the time-course of cycloplegia, with dark irides requiring up to 40 min to reach full loss of accommodation, compared with only 10 min in individuals with light iris colour. While mydriasis accompanies cycloplegia, the increase in pupil size lags behind the loss of accommodation.9
MFRP variant results in nanophthalmos, retinitis pigmentosa, variability in foveal avascular zone
Published in Ophthalmic Genetics, 2023
Claire Vanden Heuvel, Breanna Aldred, Tyler Boulter, Rachel Sullivan, James Ver Hoeve, Melanie Schmitt
Medical records of two affected siblings and one unaffected sibling were reviewed. All examinations were performed by a single pediatric ophthalmologist (MAS). Ophthalmic examination included best corrected visual acuity (BCVA), IOL master ocular biometry, slit lamp examination, rebound tonometry (iCare), ocular motility assessment, and dilated fundus examination. Cycloplegia was obtained with instillation of cyclopentolate 2.0% eye drops. Refraction was performed 40 minutes afterward by means of retinoscopy. Spectral domain optical coherence tomography (SD-OCT) was obtained with Zeiss Cirrus systems (Zeiss Meditec, Inc. Dublin, CA). Full field ERG was performed using a RETeval acquisition device (LCK Technologies, Inc. Gaithersburg, MD). Full-field ERGs were recorded per the ISCEV (2015 update) Standard including light-adapted (LA) single and 28 Hz flicker 3.0 cd-s m−2 and dark-adapted (DA) 0.01, 3.0 and 10.0 cd-s m−2 conditions (9). Fundus photographs were obtained with Topcon ImagenetR4 (Topcon Medical Systems, Inc. Oakland, NJ). Genetic analysis for Patient 1 was performed with a 266 gene inherited retinal dystrophy panel. Genetic analysis for Patient 2 was performed via familial variant testing.
Related Knowledge Centers
- Accommodation
- Ciliary Muscle
- Cycloplegia
- Muscarinic Antagonist
- Mydriasis
- Parasympathomimetic Drug
- Tropicamide
- Atropine
- Pediatrics
- Eye Examination