title: Paediatric cycloplegia: a new approach.
abstract: BACKGROUND
  Cycloplegia is a traumatic experience for most children, as guttae cyclopentolate stings on instillation into the conjunctival sac. This may result in inadequate cycloplegia, difficulty in further examination and a child who is scared of both the doctor and the ophthalmology department. Guttae proxymetacaine hydrochloride 0.5% (Ophthaine, Proparacaine) is a topical local anaesthetic that does not sting on instillation.
  
  
  METHODS
  Eighty-eight consecutive children in the paediatric clinic were assessed. The response of the patient to previous use of cyclopentolate alone was assessed by the parents of the child using a grading scheme. The use of proxymetacaine prior to instillation of cyclopentolate was then assessed using the same grading system.
  
  
  RESULTS
  Seventy per cent of the children who received cyclopentolate alone were assessed to have cried and been unhappy. Ninety-one per cent of the children who received cyclopentolate after proxymetacaine were assessed to have shown no adverse reaction to the cycloplegia and remained happy.
  
  
  CONCLUSIONS
  This study shows that use of proxymetacaine prior to cyclopentolate results in atraumatic cycloplegia in children. This can confer multiple benefits on the doctor-patient relationship.
authors.affiliation: Moorfields Eye Hospital, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Shah
authors.forename: A S
authors.initials: AS
authors.lastname: Jacks
authors.forename: G G
authors.initials: GG
authors.lastname: Adams
mesh_terms: D000779:Anesthetics, Local; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003519:Cyclopentolate / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009184:Mydriatics / Q000009:adverse effects*; D009883:Ophthalmic Solutions; D011430:Propoxycaine; D011446:Prospective Studies; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control
chemical_list: D000779:Anesthetics, Local; D009184:Mydriatics; D009883:Ophthalmic Solutions; C005717:proxymetacaine; D011430:Propoxycaine; D003519:Cyclopentolate