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 Formulary Chapter 11: Eye - Full Chapter
11.05  Expand sub section  Mydriatics and cycloplegics
 note 
  • The lowest strength of solution should always be used for children.
  • Mydriasis should not be carried out in patients with a predisposition to acute angle-closure glaucoma (due to a shallow anterior chamber and/or small diameter cornea). If using drops in children, apply pressure over the lachrymal sac for 1 minute after instillation.
  • Do not use mydriatics in unconscious patients, as their effects will prevent reaction of the pupils to light and would affect any subsequent neurological examination.
Tropicamide
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First Choice
Green
Single use eye drops.
Produces rapid-onset mydriasis of short duration, maximal effect after 40-60 minutes. Recovery occurs over 6-8 hours. It produces some cycloplegia and is used to visualise the fundus for short procedures. 
Cyclopentolate Hydrochloride Eye drops.
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First Choice
Green
Longer duration of action, reaching its maximal effect in 30-60 minutes. This lasts for about 45 minutes; complete recovery may take up to 24 hours. It can be used for visualisation of the fundus, refraction studies, or in the treatment of iridocyclitis if the patient is allergic to atropine 
Atropine Sulphate
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Restricted Drug Restricted
Green
Atropine eye drops or single use eye drops.
Used to prevent posterior synechiae in uveitis and iridocyclitis. The effects of atropine can last for up to 14 days. Systemic toxicity from atropine absorption occurs quite often, especially in elderly or very young patients. In particular elderly patients may become confused. 
   
Phenylephrine Hydrochloride
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Restricted Drug Restricted
Green
Single use eye drops.
Phenylephrine can be used alone or in conjunction with the other agents to produce wide mydriasis. 
   
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Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Black

Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety. All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry   

Red

Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).  

Amber SCA

Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.   

Amber Simple

Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.  

Green Conditional

Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence see comments under individual entries.   

Green

Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.   

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