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Antimuscarinic (Mydriatic) Pregnancy: Caution — limited data; avoid prolonged use

Tropicamide

Brand names: Mydriacyl

Adult dose

Dose: Fundus examination: 1 drop of 1% solution per eye, 15–20 min before examination. Repeat if needed.
Route: Topical ophthalmic
Frequency: As required for examination
Max: 2 drops per eye per examination
Short-acting (effects last 4–8h). For pupil dilation before fundoscopy, retinal photography, ophthalmoscopy. Warn patients about blurred near vision and photosensitivity — do not drive for 4–8h.

Paediatric dose

Route: Ophthalmic
Frequency: As needed for examination
Max: 0.5% (1 drop) for children (lower concentration)
Concentration: 0.5% or 1% solution drop/ml
Children: use 0.5% solution. Neonates: systemic toxicity risk — 0.5% or lower; press nasolacrimal duct after instillation. Premature infants: specialist assessment before using dilating drops.

Dose adjustments

Renal

N/A

Hepatic

N/A

Clinical pearls

  • Angle-closure precipitation: rare but important — always screen for shallow anterior chamber before dilating; do not dilate if suspected angle-closure
  • Duration counselling: warn patient blurred vision for 4–8h — no driving, reading may be difficult; come with a companion if possible
  • Neonatal systemic effects: fever, tachycardia, vasodilation — report to neonatologist if concerning
  • Cyclopentolate (stronger, longer-acting) or atropine (longer-acting): used for cycloplegia (refraction)

Contraindications

  • Suspected narrow-angle glaucoma
  • Anterior chamber angle closure (acute angle-closure glaucoma risk)

Side effects

  • Photophobia and blurred vision (4–8h)
  • Transient IOP rise (rarely triggers angle-closure glaucoma in susceptible patients)
  • Systemic antimuscarinic effects (especially in children): tachycardia, fever, flushing, dry mouth
  • Psychosis-like agitation (in overdose)

Interactions

  • Other antimuscarinics — additive systemic effects

Monitoring

  • IOP in susceptible patients (narrow angles)
  • Visual acuity recovery post-examination

Reference: BNFc; BNF; BNF for Children; RCOphth Examination Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways