title: The psychological impact of eyedrops administration in children.
abstract: OBJECTIVE
  To determine the psychological effects of eyedrops administration in children.
  
  
  METHODS
  Children requiring eyedrops for cycloplegic refraction were recruited in this cross-sectional study. Nurses administered eyedrops in 2-3 cycles spaced 5-10 minutes apart, and optometrists performed refraction 30 minutes after the last drop. Ophthalmologists, nurses, and optometrists rated the children's cooperation level at first review, after each eyedrop, at refraction, and at final review. Parents chose a personality type best describing their child, and monitored their child's anxiety using a modified Yale Preoperative Anxiety Scale (m-YPAS). Children were "uncooperative" if nurses noted significant distress during the first drop cycle.
  
  
  RESULTS
  A total of 298 children 2-12 years of age were included. Of these, 77 (26%) experienced pre-drop distress and 39 (13%) were uncooperative with drops. Compared to cooperative children, uncooperative children tended to be younger (2.0-4.9 years vs ≥8 years; OR, 4.11; 95% CI, 1.14-14.83; P = 0.031), male (OR, 2.55; 95% CI, 1.06-6.10; P = 0.036), have had a previous negative eyedrop experience (84.2% vs 25.3%; P < 0.001) and were more anxious (m-YPAS scores, 41.4 ± 22.0 vs 30.6 ± 12.6: P < 0.001). Children described as "demanding and aggressive" were more uncooperative than "timid and anxious" children. It took longer to instill drops (3.1 vs 1.3 minutes), and perform refraction (11.6 vs 7.2 minutes) in uncooperative children.
  
  
  CONCLUSIONS
  A small group of children were uncooperative with eyedrops and 26% experienced significant pre-drop anxiety. Factors such as age, sex, a previous negative eyedrop experience, and pre-drop anxiety, associated with uncooperativeness need to be considered when developing strategies to improve the eyedrops experience in children.
authors: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Jane Lim
authors: JL
authors: Sujuan
authors: Department of Ophthalmology, KK Women's and Children's Hospital, Singapore.
authors: Swati
authors: S
authors: Handa
authors: Department of Ophthalmology, KK Women's and Children's Hospital, Singapore.
authors: Champika
authors: C
authors: Perera
authors: Department of Ophthalmology, KK Women's and Children's Hospital, Singapore; Pediatric Ophthalmology and Adult Strabismus Service, Singapore National Eye Centre, Singapore. Electronic address: wla_chia@yahoo.com.
authors: Audrey
authors: A
authors: Chia
mesh_terms: D000287:Administration, Topical; D001008:Anxiety Disorders / Q000523:psychology; D044466:Asian People / Q000523:psychology; D002648:Child; D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003519:Cyclopentolate / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D009184:Mydriatics / Q000008:administration & dosage*; D009883:Ophthalmic Solutions; D010349:Patient Compliance / Q000523:psychology; D010555:Personality Inventory; D010656:Phenylephrine / Q000008:administration & dosage; D011430:Propoxycaine / Q000008:administration & dosage; D012029:Refraction, Ocular / Q000502:physiology; D012846:Singapore; D013315:Stress, Psychological / Q000208:ethnology / Q000523:psychology*; D014331:Tropicamide / Q000008:administration & dosage
chemical_list: D009184:Mydriatics; D009883:Ophthalmic Solutions; D010656:Phenylephrine; C005717:proxymetacaine; D011430:Propoxycaine; D003519:Cyclopentolate; D014331:Tropicamide