title: Dilating dangerous pupils.
abstract: Altogether 85 eyes from patients at risk to the development of closed-angle glaucoma were dilated with either parasympatholytic or sympathomimetic drugs. Of 21 eyes dilated with cyclopentolate 1/2%, 9 developed angle closure and a significantly raised pressure at some stage during dilatation and subsequent miosis. Of 58 eyes dilated with tropicamide 1/2%, 19 developed angle closure and a significantly raised pressure during dilatation. Treatment with intravenous acetazolamide and pilocarpine rapidly returned pressure to normal levels. Six eyes that had previously had a positive provocative test with simultaneous pilocarpine and phenylephrine were safely dilated with phenylephrine alone. Subsequent miosis with pilocarpine produced closed-angle glaucoma in all eyes. The significance of these observations is explained and discussed, and it is suggested that high-risk eyes should never be dilated with cyclopentolate. Tropicamide is safe if elementary precautions are observed. Safest of all, however, is phenylephrine-induced mydriasis and subsequent miosis with thymoxamine drops 1/2%.
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D003519:Cyclopentolate / Q000009:adverse effects; D005901:Glaucoma / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D008916:Miotics / Q000009:adverse effects*; D013948:Moxisylyte / Q000009:adverse effects; D009184:Mydriatics / Q000009:adverse effects*; D010656:Phenylephrine / Q000009:adverse effects; D010862:Pilocarpine / Q000627:therapeutic use
chemical_list: D008916:Miotics; D009184:Mydriatics; D010862:Pilocarpine; D010656:Phenylephrine; D003519:Cyclopentolate; D000086:Acetazolamide; D013948:Moxisylyte