title: Does prior instillation of a topical anaesthetic alter the pupillary mydriasis produced by tropicamide (0.5%)?
abstract: OBJECTIVE
  It is common clinical practice to instill a topical anaesthetic prior to the instillation of a mydriatic agent into the eye. The main rationale for using the anaesthetic is to increase corneal permeability, so that more of the mydriatic agent reaches the receptor sites within the anterior chamber. It addition, as mydriatics generally cause stinging, prior use of an anaesthetic should reduce the degree of discomfort. The aim of the present study was to determine whether the efficacy of mydriasis produced by an antimuscarinic agent is enhanced by prior instillation of a topical anaesthetic.
  
  
  METHODS
  The study was performed using a double-masked protocol on 20 healthy young subjects. One drop of either proparacaine (proxymetacaine) (0.5%) or isotonic saline was instilled into the eye, followed by one drop of tropicamide (0.5%). Pupil diameter was measured using a customized photographic device at 0, 10, 20, 30 and 60 min following drug instillation. Additionally, subjects were asked to rate the degree of discomfort following the instillation of each drop on a scale from 0 (no discomfort) to 10 (agony).
  
  
  RESULTS
  There was no significant difference in either the rate of onset of mydriasis, or the maximum pupil diameter achieved between the two conditions. The mean change in pupil diameter produced by tropicamide after the instillation of saline or proparacaine was 2.31 and 2.28 mm, respectively. The mean discomfort scores following instillation of saline and proparacaine were 1.15 and 1.65, respectively, while mean discomfort scores following the instillation of tropicamide after saline or proparacaine were 4.00 and 0.85, respectively.
  
  
  CONCLUSIONS
  Instillation of a topical anaesthetic does significantly reduce the degree of discomfort produced by the instillation of tropicamide. However, it does not produce any significant increase in either the magnitude or rate of onset of mydriasis.
authors.affiliation: SUNY College of Optometry, New York, NY 10036, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Haddad
authors.forename: Mark
authors.initials: M
authors.lastname: Rosenfield
authors.forename: Joan K
authors.initials: JK
authors.lastname: Portello
authors.forename: David M
authors.initials: DM
authors.lastname: Krumholz
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D009184:Mydriatics / Q000008:administration & dosage*; D010147:Pain Measurement / Q000523:psychology; D011430:Propoxycaine / Q000008:administration & dosage*; D011680:Pupil / Q000187:drug effects*; D014331:Tropicamide / Q000008:administration & dosage*
chemical_list: D000779:Anesthetics, Local; D009184:Mydriatics; C005717:proxymetacaine; D011430:Propoxycaine; D014331:Tropicamide