From the Guidelines
Tropicamide can cause side effects, including hypersensitivity reactions, fever, dry mouth, rapid pulse, nausea, vomiting, flushing, somnolence, and behavioral changes, as reported in the most recent study published in 2023 1. The side effects of tropicamide are primarily due to its mechanism of action as a cycloplegic agent, which blocks the action of acetylcholine in the eye, affecting the muscles that control pupil size and focusing ability. Some of the common side effects of tropicamide include:
- Hypersensitivity reactions
- Fever
- Dry mouth
- Rapid pulse
- Nausea
- Vomiting
- Flushing
- Somnolence
- Behavioral changes, such as delirium, although rare These side effects can be managed by punctal occlusion, which may be useful in reducing their severity, as suggested in a recent study 2. It is essential to note that the use of topical anesthetic prior to the cycloplegic agent can reduce the stinging and promote penetration of subsequent eyedrops, as reported in the study 1. In cases of severe reactions, patients should be referred to an emergency care setting, and physostigmine may be administered, as recommended in the study 2. Overall, while tropicamide can cause side effects, they are generally temporary and resolve as the medication wears off, typically within a few hours. However, patients should be advised to avoid driving or operating machinery until their vision returns to normal and to protect their eyes from bright light while their pupils are dilated. If patients experience severe or persistent side effects, they should contact their healthcare provider immediately.
From the FDA Drug Label
ADVERSE REACTIONS Ocular: Transient stinging, blurred vision, photophobia and superficial punctuate keratitis have been reported with the use of tropicamide. Increased intraocular pressure has been reported following the use of mydriatics. Non-Ocular: Dryness of the mouth, tachycardia, headache, allergic reactions, nausea, vomiting, pallor, central nervous system disturbances and muscle rigidity have been reported with the use of tropicamide. Psychotic reactions, behavioral disturbances, and vasomotor or cardiorespiratory collapse in children have been reported with the use of anticholinergic drugs.
The side effects of Tropicamide (Mydriacyl) include:
- Ocular side effects: + Transient stinging + Blurred vision + Photophobia + Superficial punctuate keratitis + Increased intraocular pressure
- Non-ocular side effects: + Dryness of the mouth + Tachycardia + Headache + Allergic reactions + Nausea + Vomiting + Pallor + Central nervous system disturbances + Muscle rigidity + Psychotic reactions + Behavioral disturbances + Vasomotor or cardiorespiratory collapse (in children) 3
From the Research
Side Effects of Tropicamide (Mydriacyl)
- The use of Tropicamide can lead to increased intraocular pressure in some individuals, particularly those with open-angle glaucoma who are being treated with pilocarpine 4.
- There is a risk of acute angle-closure glaucoma after diagnostic mydriasis with Tropicamide, especially in nonselected subjects aged 55 years and over 5.
- Tropicamide can cause angle closure and significantly raised pressure during dilatation in eyes at risk of developing closed-angle glaucoma 6.
- The drug may also cause elevation of intraocular pressure in eyes with open angle glaucoma, possibly due to competitive inhibition of the miotic at the receptor site 4.
- In some cases, the use of Tropicamide has been associated with heavy pigment showers in the anterior chamber, suggesting an outflow obstructive phenomenon similar to that seen in "Pigmentary Glaucoma" 4.
- However, one study found that Tropicamide 1% had a relatively small effect on intraocular pressure in normal eyes and those with untreated open angle glaucoma 4.
- Another study suggested that Tropicamide is safe to use if elementary precautions are observed, and that it is safer than cyclopentolate for dilating high-risk eyes 6.