From the Guidelines
Pupillary dilation is contraindicated in patients with primary angle closure or suspected occludable angles, as it can precipitate acute angle closure crises (AACC) 1.
Contraindications to Mydriasis
- Primary angle closure: patients with primary angle closure should avoid pupillary dilation, as it can worsen the condition and lead to AACC 1
- Suspected occludable angles: caution should be exercised when dilating patients with suspected occludable angles, as dilation can precipitate AACC 1
- Intermittent angle closure: patients with intermittent angle closure should be warned about the risks of AACC and the potential for certain medications to provoke pupillary block 1
Medications to Avoid
- Anticholinergic medications: patients with primary angle closure or suspected occludable angles should avoid medications with anticholinergic properties, such as over-the-counter decongestants, cold and flu medications, allergy medications, and sleeping aids, as they can cause pupil dilation and induce AACC 1
Precautions
- Cautious dilation: if dilation is deemed essential, cautious dilation with low-strength tropicamide can be performed, and patients should be monitored for signs and symptoms of AACC 1
- Iridotomy: patients with primary angle closure or suspected occludable angles should be considered for iridotomy to prevent AACC, especially if they require frequent dilated eye examinations or are at risk of developing AACC due to medication use or other factors 1
From the Research
Contraindications to Pupillary Dilation
- There are limited studies that directly address the contraindications to pupillary dilation (mydriasis) 2.
- However, it can be inferred that patients with certain eye conditions, such as glaucoma, may be at risk of angle closure if they experience prolonged pupil dilation 3.
- Additionally, patients who have had previous ocular trauma or surgery may need to be approached with caution when considering pupillary dilation.
Specific Conditions
- Angle closure glaucoma: patients with this condition may be at risk of worsening their condition if they experience prolonged pupil dilation 3.
- Ocular trauma or surgery: patients who have had previous ocular trauma or surgery may need to be approached with caution when considering pupillary dilation, although there is limited evidence to support this claim.
Pharmaceutical Considerations
- Certain medications, such as calcium channel blockers, can cause prolonged pupil dilation and may be contraindicated in patients with certain eye conditions 3.
- The use of mydriatic agents, such as tropicamide and phenylephrine, can cause prolonged pupil dilation and may be contraindicated in patients with certain eye conditions 4, 5, 6.