Dose:    1 drop each eye

Comments: Tropicamide is an anticholinergic agent used for mydriasis and cycloplegia.  The time for maximum mydriasis ranges from 15 to 30 minutes; the time for maximum cycloplegia ranges from 15 to 45 minutes. It acts more slowly than cyclopentolate (Cyclogyl) but has a shorter duration of effect.  The duration of action usually lasts up to 6 hours. Problems encountered with the use of this drug in infants should be rare. To minimize absorption, use only one drop per eye and apply gentle digital pressure over the nasolacrimal sac for 2 to 3 minutes after installation. The standardized procedure for an eye exam consists of:

1. One drop 1.0% Tropicamide in each eye.

Further comments on tropicamide.

Toxicity: Use of cyclopentolate has been associated with psychotic reactions and behavioral disturbances in children using the 2% concentration. These disturbances include ataxia, restlessness, hallucinations, hyperactivity, failure to recognize people, and seizures. Tropicamide produces reactions similar to those of other anticholinergic drugs, but the CNS manifestations are more common. Other toxic manifestations of anticholinergic drugs are tachycardia, hyperpyrexia, vasodilatation, urinary retention, decreased secretions in the respiratory tract & the salivary glands. Bauer et al. (J Pediatr 1973; 82:501) reported two infants who developed GI symptoms associated with cyclopentolate use. They infants developed vomiting, abdominal distention, and an ileus.

Preparation: Tropicamide (Mydriacyl) is available as a 1% solution in 3 ml drop-tainer dispensers. Store at room temperature. Once opened, good for one year. May be stored in refrigerator. Label with patient’s name if choosing to re-use drug for subsequent eye exams. Discard it tip is contaminated.