Is Long-Term Use of Mydriatics Safe for Open-Angle Glaucoma Patients?

Is it suitable for patients with open-angle glaucoma to use mydriatics long-term to relieve eye fatigue?

Hello, I am a 54-year-old patient with open-angle glaucoma, cataracts, and myopia.

1.
What are the indications for using mydriatic agents in ophthalmology? From the information I have gathered, mydriatic agents are typically used in the following three situations: (1) To dilate the pupil for retinal examination or surgery - during clinical examination of the retina, mydriatic agents are administered to prevent the patient's eyes from being sensitive to bright light.
(2) Pain relief - mydriatic agents relax the ciliary muscle, which can be beneficial for postoperative patients or those with eye inflammation to reduce pain.
(3) Myopia - long-acting mydriatic agents have been shown to reduce axial elongation and prevent the progression of myopia.
In addition to these three points, would short-acting mydriatic agents be recommended for relieving eye fatigue symptoms? Is it appropriate for glaucoma patients to use them routinely for fatigue relief?
2.
It is understood that mydriatic agents do not increase intraocular pressure in patients with open-angle glaucoma.
However, while most short-acting mydriatic agents do not have severe side effects, they not only relax the ciliary muscle but also forcibly dilate the pupil.
Long-term use of mydriatic agents may allow more light to enter the eye through the lens compared to the average person, potentially increasing the risk of photophobia, cataracts, and macular degeneration.
Given my conditions of glaucoma and cataracts, is it suitable for me to use mydriatic agents long-term for alleviating eye fatigue? If not, aside from reducing screen time and ensuring adequate rest for my eyes, what other medications would you recommend for relief?
3.
For individuals without specific eye diseases, would you recommend using short-acting mydriatic agents as a solution for general eye fatigue?
4.
Additionally, is it necessary to check intraocular pressure to ensure it is within normal limits before administering mydriatic agents during an eye examination? If the intraocular pressure is above normal, can mydriatic agents still be used for the examination?
I sincerely appreciate your professional assistance in addressing these questions.
Thank you!

Ms. Li, 50~59 year old female. Ask Date: 2024/04/23

Dr. He Jianxian reply Ophthalmology

Dear Ms.
Li,
1.
Mydriatic agents are not intended for routine use to alleviate eye fatigue, and this applies to both glaucoma and non-glaucoma patients.
2.
Clinically, the routine use of mydriatic agents as a choice for relieving eye fatigue is not recommended; please discuss this with your physician.
3.
Alleviating eye fatigue is not a standard indication for the use of mydriatic agents.
4.
Unless there is a concern for angle-closure glaucoma, mydriatic agents can still be used for examination in cases of elevated intraocular pressure.
Director He Jianxian, Ophthalmology Department, Nantou Hospital

Reply Date: 2024/04/23

More Info

When it comes to the long-term use of mydriatics (dilating drops) for patients with open-angle glaucoma, there are several important considerations to keep in mind. Mydriatics are commonly used in ophthalmology for various purposes, including retinal examinations, pain relief, and managing certain refractive errors. However, their use in patients with glaucoma, particularly open-angle glaucoma, requires careful evaluation.

1. Indications for Mydriatics: Mydriatics are typically used in the following scenarios:
- Retinal Examination: They are essential for dilating the pupil to allow a comprehensive examination of the retina and optic nerve.

- Post-Surgical Pain Relief: Mydriatics can help relax the ciliary muscle, providing relief from pain after eye surgery or in cases of inflammation.

- Myopia Management: Long-acting mydriatics have been shown to slow the progression of myopia by reducing axial elongation.

2. Safety in Open-Angle Glaucoma: For patients with open-angle glaucoma, the use of mydriatics does not typically increase intraocular pressure (IOP) significantly, which is a primary concern in glaucoma management. However, while short-acting mydriatics are generally considered safe, long-term use is not recommended for routine relief of eye fatigue. This is because prolonged exposure to increased light sensitivity and potential side effects may outweigh the benefits.

3. Risks of Long-Term Use: Although mydriatics do not inherently raise IOP in open-angle glaucoma patients, there are potential risks associated with their long-term use. Chronic exposure to increased light can lead to discomfort and may increase the risk of developing cataracts or macular degeneration, especially in patients with pre-existing conditions like cataracts and glaucoma. Therefore, using mydriatics solely for eye fatigue relief is not advisable.

4. Alternatives for Eye Fatigue: For managing eye fatigue, especially in the context of excessive screen time, it is recommended to take regular breaks, practice the 20-20-20 rule (every 20 minutes, look at something 20 feet away for 20 seconds), and use artificial tears to maintain moisture. If necessary, consult with an eye care professional for appropriate treatments that do not involve mydriatics.

5. Pre-Examination Protocol: Before using mydriatics for an eye examination, it is crucial to check the patient's IOP. If the IOP is elevated, the use of mydriatics may need to be reconsidered, as it could pose a risk for acute glaucoma attacks, particularly in patients with narrow angles. In such cases, alternative examination methods or medications should be explored.

In conclusion, while mydriatics can be safely used in open-angle glaucoma patients for specific purposes, their long-term use for alleviating eye fatigue is not recommended. It is essential to discuss any concerns with your ophthalmologist, who can provide tailored advice based on your specific condition and overall eye health. Regular monitoring and appropriate management strategies are key to maintaining eye health in glaucoma patients.

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