These comprehensive notes are perfect for any orthoptic students studying their last year with an upcoming medical exemptions exam/module or any practicing orthoptists studying for this additional qualification.
Intro and legal classification
All general list sales, all pharmacy
medicines and the following
prescription meds:
Atropine, cyclopentolate, tropicamide,
lidocaine with fluorescein,
oxybuprocaine, proxymetacaine,
tetracaine, chloramphenicol, fusidic
acid
GSL i.e. artificial; tears for dry eye,
pharmacy medicines i.e. phenylephrine
2.5 and 10% for pupil dilation
PM also include sodium cromoglycate
2%, antazoline 0.5% and
xylometazoline hydrochloride 0.05%
which are used as treatments for
seasonal allergic conjunctivitis and
perennial allergic conjunctivitis
The module will cover:
Atropine
Cyclopentolate
Tropicamide
Phenylephrine
Lidocaine with fluorescein
Oxybuprocaine
Proxymetacaine
Tetracaine
Chloramphenicol
Fusidic acid
, Cycloplegia and mydriasis 1
Cycloplegia Drug Notes Cautions Interactions Side effects
Parasympathetic nervous system innervates ciliary body Minims or Pigmented Other drugs Photophobia
By administering Atropine 1% multi-use irides with anti- Stinging
cycloplegics/antimuscarinics/parasympatholytic, innervation is muscarinic Confusion, vision disorders
temporarily stopped as the drug competes with acetylcholine on POM Narrow effects Constipation
the post-synaptic membrane of the ciliary muscle angle Dizziness, drowsiness
3mths - (closed Levodopa Dry mouth
Drug will occupy receptor sites but depolarisation does not
17yrs angle (Parkinson’s) Dyspepsia
occur
glaucoma) Flushing, skin reactions
This causes the impulse started at the Erdinger-Westphal
Phenylephrine Headache, nausea,
nucleus to be ineffective temporarily so does not travel via 3rd
Neonates – risk of vomiting
CN to activate ciliary muscle
severe Palpitations, tachycardia
This results in temporary paralysis in accommodation
hypertension Urinary disorders
Use of cycloplegics
Minims or Pigmented Other drugs Abdominal distension
Paediatric refraction – allows for true refractive state of eye to
Cyclopentolat muti-use irides with anti- Behaviour abnormal
be investigated especially for ET – GS previously atropine 1%
e 0.5% 1% muscarinic Cardio-respiratory distress,
but now is cyclopentolate 1% as it is fast-acting, wears off faster
POM Narrow effects palpitations
but allows for adequate refraction, less likely to cause
angle Constipation, GI disorders,
local/systemic side effects
Risk of (closed Levodopa vomiting
Amblyopia therapy – atropine 1% in better seeing eye was
amblyopia angle (Parkinspn’s Dry mouth
found to be as effective as patching for 6hrs when instilled 2
in under glaucoma) as absorption Conjunctivitis (prolonged
days a week according to a PEDIG study involving 419 children
3mth olds reduced) administration)
– atropine is longer lasting than cyclopentolate and close
Neonates Flushing
monitoring is vital and is checked by dynamic retinoscopy
3mths – 12 Hyperaemia (prolonged
Uveitis – particularly anterior uveitis – inflammation of uveal years 1% administration)
tract/iris and ciliary body causing painful uniocular red eye Over 12s Mydriasis
affecting vision – photophobia present and history of 0.5% Urinary disorders
inflammatory disease i.e. rheumatism Psychotic disorder
o Slit lamp shows: Minims or Pigmented Other drugs Eye erythema
Circum-limbal injection Tropicamide multi-use irides with anti- Eye irritation (prolonged)
Cells in anterior chamber 0.5% 1% muscarinic Eye pain
Keratic precipitate POM Narrow effects Hypotension
Hypopyon angle Nausea
Misshapen pupil due to posterior synechiae 1% for (closed Levodopa Syncope
Cyclopentolate 1% given to break refn. in angle Vision blurred
synechiae teens/older glaucoma) Clozapine –
Steroids to reduce inflammation kids + 1 drp risk of
Alleviation of accommodative spasm – i.e. in cases of after 5 Neonates intestinal
corneal abrasion, ciliary muscle goes into spasm and mins obstruction
cyclopentolate 1% can be administered to alleviate pain
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