From the Guidelines
Atropine eye drops are a suitable alternative to cyclopentolate eye drops.
Alternatives to Cyclopentolate Eye Drops
- Atropine: Atropine is a commonly used alternative to cyclopentolate, with studies showing its efficacy in slowing the progression of myopia 1. Atropine 0.01% has been found to have minimal side effects and is effective in controlling myopia progression.
- Tropicamide: Tropicamide 1% has been used in combination with phenylephrine hydrochloride 2.5% to produce adequate dilation and cycloplegia, although it was found to have no significant difference in the progression of myopia compared to controls in one study 1.
- Pirenzepine hydrochloride: Pirenzepine hydrochloride 2% ophthalmic gel has been evaluated in two multicenter, double-masked, placebo-controlled parallel studies and was found to be effective and relatively safe in slowing myopia progression over a 1-year treatment period 1.
Important Considerations
- The choice of alternative to cyclopentolate eye drops depends on the individual patient's needs and the specific condition being treated.
- Atropine is a commonly used alternative, but it can have side effects such as photosensitivity, conjunctival irritation, and systemic effects like dryness of the mouth and skin, fever, delirium, and tachycardia 1.
- The use of topical anesthetic prior to the cycloplegic agent can reduce stinging and promote penetration of subsequent eyedrops 1.
From the Research
Alternatives to Cyclopentolate Eye Drops
Alternatives to cyclopentolate eye drops include:
- Tropicamide: a viable substitute for cyclopentolate due to its rapid onset of action 2, 3
- Atropine: has the strongest cycloplegic effect and is recommended for cases of large accommodative esotropia, but has undesired side effects and risks 4
- Phenylephrine: can be used in combination with tropicamide or cyclopentolate for mydriasis 5
- Cycolmydril: can be used under six months old as recommended by the AAO 4
Comparison of Alternatives
Studies have compared the efficacy of cyclopentolate and tropicamide in controlling accommodation during refraction:
- A meta-analysis found that the cycloplegic effect of cyclopentolate was stronger than tropicamide, but the difference was only statistically significant in children, hyperopic patients, and with retinoscopy 2
- A randomized clinical trial found that tropicamide 1% and cyclopentolate 1% had similar effects on cycloplegic refraction in pediatric patients with brown irides 3
Stability of Alternatives
The stability of extemporaneously prepared ophthalmic solutions containing combinations of phenylephrine, tropicamide, and cyclopentolate has been evaluated:
- A stability study found that adult and pediatric ophthalmic formulations containing combinations of phenylephrine, tropicamide, and cyclopentolate were stable physically and chemically for up to 60 days when stored at refrigeration temperatures (2-8 °C) 5