Dilation efficacy: is 1% cyclopentolate enough?

Background: Pediatric eye examinations include cycloplegia and dilation. Most clinicians use 2 or 3 different medications in drop or spray form to ease instillation. We studied whether a single drop of a cycloplegic agent would provide effective dilation as well.

Methods: Children between the ages of 1 and 7 years, who presented for a routine eye examination, were recruited to participate. Each child received 1% cyclopentolate in the right eye (group A), and either tetracaine with cyclopentolate (group B) or tetracaine with cyclopentolate with phenylephrine (group C) in the left eye. At the completion of the examination, a digital picture was taken of the patient's pupils. A separate observer measured the pupil diameter and classified iris color.

Results: The mean pupil size for all subjects was: 6.19 mm +/- 1.33 mm, for group A, 6.56 mm +/- 1.25 for group B; and 6.47 mm +/- 1.12 for group C. Light-colored iris patients had greater dilation as a group and darker iris patients had less dilation as a group. Evaluation of the paired eyes pupil diameter found no statistical difference.

Conclusions: One drop of 1% cyclopentolate provides cycloplegia and effective pupil dilation for completion of a pediatric eye examination. One drop is easier to instill than multiple drops and should be considered for use in a pediatric eye examination.