the Use of Mydriatic Agents in Pediatric Eye Care - Ophthalmology

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The use of mydriatics?


Dear Dr.
Tsai,
I have a question regarding my 9-year-old daughter.
Today (February 24), she had a follow-up appointment at the ophthalmology clinic, and after dilation, it was found that her myopia has worsened (left eye from -5.00 to -12.50, right eye from 0.00 to -5.00).
After returning home, the effects of the dilation have not worn off, but she has shown no unusual symptoms in her daily routine.
Since she usually uses a short-acting dilating agent (Tropicamide) before bedtime, I am wondering:
1.
Is it advisable to administer the dilating agent when she returns home from school (around 4 PM) if she will be indoors?
2.
If so, would writing homework under a desk lamp without wearing sunglasses harm her eyes?
3.
If both 1 and 2 are acceptable, wouldn’t that enhance the effectiveness?
Thank you.

jockey, 40~49 year old female. Ask Date: 2017/02/24

Dr. Cai Wenyuan reply Ophthalmology


Hello, short-acting mydriatics have a specific duration of action, and they are generally used before bedtime.
There is no better alternative method.
Wishing you peace and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2017/02/24

More Info


When it comes to the use of mydriatic agents, particularly in pediatric eye care, there are several important considerations to keep in mind. Mydriatic agents, such as Tropicamide, are commonly used to dilate the pupils for diagnostic purposes or to treat certain eye conditions. However, their use, especially in children, should be approached with caution and under the guidance of a healthcare professional.

1. Timing of Administration: You mentioned the possibility of administering the mydriatic agent after school. While it may seem convenient to use the drops after school, it is essential to consider the timing of their effects. Tropicamide typically has a duration of action of about 4 to 6 hours, but this can vary based on individual responses. Administering the drops in the afternoon could lead to prolonged pupil dilation into the evening, which may not be ideal for activities that require clear vision, such as homework or reading.

2. Effects of Light Exposure: When the pupils are dilated, the eyes become more sensitive to light. This is particularly important to consider when your child is working under a desk lamp without sunglasses. The increased light sensitivity can cause discomfort and strain, potentially leading to headaches or visual discomfort. It is advisable to ensure that your child wears sunglasses or stays in a dimly lit environment while the effects of the mydriatic agent are still present.

3. Potential Risks and Benefits: While using mydriatic agents may seem beneficial for improving vision temporarily, it is crucial to weigh the risks against the benefits. Prolonged use of mydriatic agents can lead to side effects such as increased intraocular pressure, blurred vision, and light sensitivity. Additionally, frequent use in children may not be advisable without proper medical supervision, as it could mask underlying issues or lead to dependency on the drops.

4. Monitoring and Follow-Up: Given that your daughter’s myopia has increased, it is essential to have regular follow-ups with her eye care provider. They can monitor her vision changes and adjust her treatment plan accordingly. If mydriatic agents are being used regularly, the eye care provider should evaluate the necessity and frequency of their use.

5. Alternative Approaches: Instead of relying on mydriatic agents for vision improvement, consider discussing with the eye care provider about other options for managing myopia, such as orthokeratology, multifocal contact lenses, or specific visual training exercises. These alternatives may provide more sustainable benefits without the side effects associated with frequent mydriatic use.

In conclusion, while mydriatic agents can be useful in certain situations, their use in children should be carefully considered and monitored. It is always best to follow the guidance of a qualified eye care professional who can provide personalized recommendations based on your child's specific needs and circumstances. Regular eye examinations and open communication with the eye care provider are key to ensuring your child's eye health and vision development.

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