Changes of intraocular pressure and refractive status in children following cycloplegic refraction with 1% cyclopentolate and 1% tropicamide

Kuo-Chi Hung; Hsiu-Mei Huang; Pei-Wen Lin

doi:10.1016/j.tjo.2015.06.001

Changes of intraocular pressure and refractive status in children following cycloplegic refraction with 1% cyclopentolate and 1% tropicamide

Taiwan J Ophthalmol. 2015 Jul-Sep;5(3):124-127. doi: 10.1016/j.tjo.2015.06.001. Epub 2015 Aug 24.

Authors

Kuo-Chi Hung¹, Hsiu-Mei Huang¹, Pei-Wen Lin¹

Affiliation

¹ Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Abstract

Purpose: To evaluate the effect of cycloplegic mydriasis with 1% cyclopentolate and 1% tropicamide on the intraocular pressure (IOP) and refractive status of children for cycloplegic refraction and compare the [OP and refractive changes between hyperopic and myopic groups.

Methods: This study was designed as a retrospective cohort study. Ninety one children received cycloplegic mydriasis. The IOP was measured with a noncontact tonometer before cycloplegic administration. One drop of 1% cyclopentolate was administered, which was followed by two drops of 1% tropicamide at an interval of 10 minutes. The IOP was then measured 30 minutes after tropicamide instillation. Autorefraction was assessed with an autorefractometer before and after cycloplegic mydriasis.

Results: The mean age of the 44 girls and 47 boys was 7.3 ± 2.4 years. The mean precycloplegic IOP was 14.45 ± 2.47 mmHg and the mean postcycloplegic IOP was 15.06 ± 3.08 mmHg in all eyes. A significant difference was noted in the IOP change (p = 0.033). In the 39 hyperopic eyes, the mean precycloplegic IOP and postcycloplegic IOP were 14.54 ± 2.53 mmHg and 15.69 ± 3.35 mmHg, respectively. There was a significant difference in the IOP change (p = 0.008). In the 52 myopic eyes, the mean precycloplegic IOP and postcycloplegic IOP were 14.38 ± 2.44 mmHg and 14.61 ± 2.80 mmHg, respectively (p = 0.72). There was no significant IOP change in the myopic group. The postcycloplegic IOP was significantly different between the hyperopic and the myopic groups (p = 0.021). Three eyes (3.3%) had an IOP elevation more than 5.0 mmHg after cycloplegic mydriasis. Postcycloplegic refraction showed significant hyperopic shifts in all eyes (p < 0.0001).

Conclusion: Cycloplegic mydriasis with 1% cyclopentolate and 1% tropicamide caused IOP changes in preschool and school-aged children with hyperopia. Ophthalmologists should be very cautious in monitoring IOP changes for children with cycloplegic medication use.

Keywords: children; cyclopentolate; cycloplegic mydriasis; intraocular pressure; tropicamide.