Mydriatic + LA combination (intracameral) Pregnancy: Should not be used during pregnancy — no adequate data for phenylephrine and tropicamide in pregnant women, animal studies insufficient, and lidocaine crosses the placenta; although negligible systemic uptake is expected, low systemic exposure cannot be excluded. Should not be used during breast-feeding (infants may be very sensitive to anticholinergics; small amounts of lidocaine are secreted into breast milk with a possibility of allergic reaction in the infant).

Tropicamide with phenylephrine and lidocaine

Brand names: Mydrane

Tropicamide with phenylephrine and lidocaine is a combined intracameral/ophthalmic preparation used to achieve and maintain pupil dilation with surface anaesthesia during cataract surgery, bringing together two mydriatics and a local anaesthetic.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 0.2 mL of the fixed combination (tropicamide 0.2 mg/mL + phenylephrine hydrochloride 3.1 mg/mL + lidocaine hydrochloride 10 mg/mL, e.g. Mydrane) — one ampoule for single eye use

Route: Intracameral injection, given slowly in one injection through the side port or principal port; must be administered by an ophthalmic surgeon

Frequency: Single dose at the start of the surgical procedure

Max: 0.2 mL — no additional dose should be injected, as no significant add-on effect has been demonstrated and increased endothelial cell loss was observed

Should only be used in patients who have already demonstrated, at pre-operative assessment, satisfactory pupil dilation with topical mydriatic therapy. Administration procedure per §4.2: (1) five minutes before performing the pre-operative antiseptic procedure and the first incision, instil one to two drops of anaesthetic eye drops in the eye; (2) at the beginning of surgery, slowly inject 0.2 mL by the intracameral route in one injection. ELDERLY: no dose adjustment necessary. RENAL / HEPATIC: considering the low dose and very low systemic exposure, no dose adjustment is necessary. PAEDIATRIC (non-numeric — not structured): safety and efficacy in children aged 0 to 18 years have not been established. Not recommended in cataract surgery combined with vitrectomy (vasoconstricting effects of phenylephrine), nor in subjects with a shallow anterior chamber or a history of acute narrow angle glaucoma.

Dose adjustments

Renal

No dose adjustment necessary, considering the low dose and very low systemic exposure (see §4.4)

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substances (tropicamide, phenylephrine hydrochloride and lidocaine hydrochloride monohydrate) or to any of the excipients
Known hypersensitivity to anaesthetics of the amide type
Known hypersensitivity to atropine derivatives

Side effects

Keratitis (uncommon)
Cystoid macular oedema (uncommon)
Intraocular pressure increased (uncommon)
Posterior capsule rupture (uncommon)
Ocular hyperaemia (uncommon)
Headache and hypertension (uncommon)

Interactions

No interaction studies have been performed; since systemic exposure is expected to be very low, systemic interactions are unlikely (§4.5)
Caution in patients in whom systemic sympathomimetic effects of phenylephrine would matter — hypertension, cardiac disorders, hyperthyroidism, atherosclerosis, prostate disorders, or any contraindication to systemic pressor amines (§4.4)
Caution with lidocaine in epilepsy, myasthenia gravis, cardiac conduction disturbances, congestive heart failure, bradycardia, severe shock, impaired respiratory function, or renal impairment with creatinine clearance less than 10 mL/minute (§4.4)

Clinical monograph

How it works

Tropicamide (antimuscarinic) relaxes the iris sphincter and phenylephrine (alpha-agonist) stimulates the iris dilator to produce mydriasis, while lidocaine blocks sodium channels in sensory nerves to provide local anaesthesia of the anterior segment.

Prescribing in practice

It is for intraocular surgical use by the operating surgeon, so it must be handled under sterile technique and the formulation and route confirmed, as it is not an ordinary topical drop and phenylephrine can still produce systemic cardiovascular effects.
Use with caution in patients with cardiovascular disease and where the anterior chamber is shallow, given the mydriatic and sympathomimetic components.
It supports intraoperative dilation and anaesthesia and is not a substitute for the standard pre-operative regimen where that is required.

Monitoring

Intraoperative monitoring covers pupil size and maintenance of dilation and, in susceptible patients, systemic cardiovascular response to phenylephrine.

Counselling the patient

This is given by the surgeon during your cataract operation to keep the pupil open and numb the eye.
Your vision will be blurred and the eye light-sensitive afterwards, so arrange not to drive home.
Report any chest symptoms or palpitations during the procedure to the team.

Evidence & guidelines

Intracameral combinations of mydriatics with lidocaine are an established approach to intraoperative pupil dilation and anaesthesia in cataract surgery, with phenylephrine cardiovascular cautions noted in the SPC.

Reference: SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways