Can tropicamide be omitted from pediatric dilation drops?

In this study, researchers assessed the cycloplegic and mydriatic effects of omitting tropicamide from a common pediatric eye drop combination.

Study design

This prospective study was conducted at a large academic children’s hospital in Chicago and included 75 children aged 4 to 11 years. One eye of each patient was treated with a combination of tropicamide, cyclopentolate and phenylephrine (TCP) while the other eye received cyclopentolate and phenylephrine (CP).

Outcomes

The mean differences in the spherical equivalent between the TCP and CP groups were not significantly different. Researchers noted that TCP yielded slightly larger pupils (7.7 vs. 7.3 mm; P<0.001) that were less responsive to light (5.8% vs. 8.1%; P=0.002) than CP among patients with dark irides. All pupils in both groups dilated to 6.0 mm or more; a similar proportion of eyes in both groups achieved a dilation of 7.0 mm or more.

Limitations

Since the dilation drops were dispensed in succession, the cooperation of the children may have affected the amount of drug successfully administered to the eye. To minimize the effects of poor cooperation, future studies should consider compound drops with the 2 different combinations.

Clinical significance

This paper presents good clinical evidence to support using a cyclopentolate and phenylephrine combination for dilation in children. The findings suggest omitting tropicamide does not affect cycloplegia or mydriasis in pediatric patients.