Mydrimide

• Approved Indications:
• Induction of mydriasis (pupil dilation) and cycloplegia (paralysis of accommodation) to facilitate ophthalmic examinations, including funduscopy and refraction assessment.
• Used preoperatively and intraoperatively in eye surgeries requiring pupil dilation.
• Management of anterior uveitis to relieve pain from ciliary spasm and prevent synechiae formation.
• Off-label Uses:
• Diagnostic aid in certain retinal diseases.
• Occasionally used to break posterior synechiae in uveitis.

• Adults and Pediatrics:
• Ophthalmic solution, typically 0.5% or 1% concentration.
• Instill 1–2 drops into the conjunctival sac of the affected eye(s).
• For examination: 1 drop repeated after 5–10 minutes if necessary.
• Mydriasis usually occurs within 15–30 minutes and lasts for up to 4–6 hours; cycloplegia effect lasts shorter (approximately 1–2 hours).
• Maximum frequency: Generally, no more than 3 doses within one hour.
• Special Populations:
• Use with caution in infants and elderly due to increased sensitivity and risk of systemic absorption.
• Adjust dosing based on clinical response and tolerability.
• Administration Notes:
• Avoid contact with eyelids or skin to prevent irritation.
• Remove contact lenses prior to administration; wait at least 15 minutes before reinsertion.

Tropicamide is a muscarinic receptor antagonist that competitively blocks acetylcholine at parasympathetic sites in the eye. By inhibiting muscarinic receptors on the iris sphincter and ciliary muscles, it causes relaxation of these muscles, resulting in pupil dilation (mydriasis) and paralysis of accommodation (cycloplegia). This action facilitates thorough ophthalmic examination and relieves pain from ciliary spasm.

• Absorption: Minimal systemic absorption occurs following topical ocular administration; systemic effects are rare but possible.
• Distribution: Primarily localized in ocular tissues with limited systemic distribution.
• Metabolism: Undergoes hepatic metabolism after systemic absorption.
• Elimination: Excreted mainly via renal pathways after hepatic metabolism.
• Onset: Mydriatic effect begins within 15–30 minutes.
• Duration: Effects typically last 4–6 hours; cycloplegic effects last 1–2 hours.

• Pregnancy:
• No adequate and well-controlled studies in pregnant women; use only if clearly needed.
• Lactation:
• Unknown if excreted in human milk; caution advised when administering to breastfeeding mothers.

• Primary class: Anticholinergic (Antimuscarinic) ophthalmic agent
• Subclass: Mydriatic and cycloplegic

• Known hypersensitivity to tropicamide or any component of the formulation.
• Narrow-angle glaucoma or known predisposition to angle-closure glaucoma.
• Conditions with risk of increased intraocular pressure.
• Children under 2 years (relative contraindication due to risk of systemic toxicity).

• Use with caution in patients with glaucoma; may precipitate angle-closure attack.
• Avoid use in patients with Down syndrome, as they may be more susceptible to systemic effects.
• Monitor for systemic anticholinergic effects especially in pediatric, elderly, or debilitated patients.
• Instruct patients to avoid driving or operating machinery until vision returns to normal.
• Early signs of systemic toxicity include flushing, dry mouth, tachycardia, confusion; seek immediate medical attention.

• Common:
• Blurred vision, photophobia, stinging or burning sensation on instillation.
• Ocular:
• Dry eyes, conjunctival hyperemia, transient increase in intraocular pressure.
• Systemic (rare):
• Dry mouth, headache, dizziness, tachycardia, flushing, confusion, especially in children.
• Side effects are generally mild and transient, dose-related.

• No significant systemic drug interactions reported due to minimal systemic absorption.
• Concurrent use with other anticholinergic drugs may increase risk of systemic anticholinergic effects.
• Use cautiously with other ocular medications that affect intraocular pressure.

• Tropicamide remains the preferred short-acting mydriatic agent in ophthalmology due to rapid onset and shorter duration.
• Guidelines emphasize caution in glaucoma patients and children to prevent adverse effects.
• No major changes in approved indications or dosing reported recently.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from light and excessive heat.
• Keep the bottle tightly closed when not in use.
• Avoid freezing.
• Keep out of reach of children.