Proxymetacaine 0.5% eye drops 0.5ml unit dose preservative free

Cycloplegia is crucial for reliable pediatric ophthalmology examinations. This document provides a re-commendation for pediatric cycloplegia and mydriasis for Brazilian ophthalmologists. This article was developed based on literature reviews; the clinical experience of Brazilian specialists, as obtained through questionnaires; and the consensus of the Expert Committee of the Brazilian Pediatric Ophthalmology Society. According to the best evidence and formulations available in Brazil, this committee recommends the use of one drop of 1% cyclopentolate plus one drop of 1% tropicamide in children older than 6 months and two drops of 1% tropicamide 0-5 minutes apart for those younger than 6 months. Mydriasis may be increased by a single drop of 2.5% phenylephrine. For retinopathy of prematurity screening, the recommendation is 0.5% or 1% tropicamide, administered two or three times, 5 minutes apart, and 2.5% phenylephrine, used preferably once. In all scenarios, we recommend the use of a prior drop of 0.5% proxymetacaine.

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CLINICAL RELEVANCE: Reducing the time between drop instillation and refraction reduces the time paediatric patients and young adults spend in practice, facilitating more eye examinations daily. BACKGROUND: The current procedure for paediatric cycloplegic refraction is to wait for at least 30-minutes post-instillation of a cycloplegic before measuring spherical equivalent refraction. This study compared cycloplegia at 20- and 30-minutes following 0.5% proxymetacaine and 1.0% cyclopentolate in 12-13-year-olds. METHODS: Participants were 99 white 12-13-year-olds. One drop of proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) followed by one drop of cyclopentolate hydrochloride (Minims, 1.0% w/v, Bausch & Lomb, UK) was instilled into both eyes. Spherical equivalent refraction was measured by autorefraction (Dong Yang Rekto ORK-11 Auto Ref-Keratometer) at 20- and 30-minutes post-instillation. Data were analysed through paired t-testing, correlations, and linear regression analysis. RESULTS: = 0.099). The mean spherical equivalent refraction difference between time points was small (0.049 (0.294) D, 95% confidence interval =-0.108 ̶ 0.009D). Agreement indices: Accuracy = 0.999, Precision = 0.973, Concordance = 0.972. Spherical equivalent refraction at 20- and 30-minutes differed by ≤0.50D in 92% of eyes, and by <1.00D in 95%. CONCLUSIONS: There was no clinically significant difference in spherical equivalent refraction or level of cycloplegia at 20- and 30-minutes post-eyedrop instillation. The latent time between drop instillation and measurement of refractive error may be reduced to 20 minutes in White 12-13-year-olds and young adults. Further studies must determine if these results persist in younger children and non-White populations.

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PURPOSE: This study compared the efficacy of cyclopentolate hydrochloride at 10-, 20- and 30-min post-instillation in White 6- to 7-year-olds, with and without prior instillation of proxymetacaine hydrochloride. The primary aim was to determine if accurate autorefraction values can be obtained sooner than the current standard of 30-min post-cycloplegia. The secondary aim was to investigate whether proxymetacaine hydrochloride enhances the efficiency of cyclopentolate. METHODS: Participants were 112 White 6- to 7-year-olds from the Child Eye Health Study. The right eye received 0.5% proxymetacaine hydrochloride and 1.0% cyclopentolate hydrochloride, and the left eye received only 1.0% cyclopentolate hydrochloride. Non-cycloplegic and cycloplegic refractive error (at 0, 10, 20 and 30 min) was measured using a binocular, open-field autorefractometer. Data were analysed through paired t-tests, concordance analysis, linear regression, equivalence testing and Bland-Altman analysis, using the 95% limits of agreement. RESULTS: Mean spherical equivalent refraction (SER) (SD) in the right eye at 0-, 10-, 20- and 30-min post-instillation was 0.62 (1.45) D, 1.52 (1.80) D, 1.64 (1.81) D and 1.72 (1.80) D, respectively. Mean left eye SER (SD) were 0.68 (1.24) D, 1.42 (1.66) D, 1.56 (1.66) D and 1.68 (1.72) D, respectively. Bland-Altman analysis showed a high level of agreement, and equivalence testing confirmed that there was no clinically significant difference in SER at 20 and 30 min in both eyes (within ±0.50 D), with mean differences of 0.08 (0.23) D in the right eye and 0.13 (0.30) D in the left eye (p = 0.21). However, SER at 10 and 30 min were equivalent in the right eye only. CONCLUSIONS: Accurate autorefraction values can be obtained 20-min post-instillation of 1.0% cyclopentolate in white children aged 6-7 years, potentially reducing clinical testing times. Proxymetacaine pre-instillation allows for reliable measurements as early as 10-min post-instillation of cyclopentolate. Further research is needed to validate these findings in non-White populations and to determine the safe discharge time post-proxymetacaine instillation.

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Background/Objectives: To evaluate the efficacy and safety of using the preservative-free topical proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch &amp; Lomb, UK) to control postoperative pain after epithelium-off corneal crosslinking (CXL) for keratoconus. Methods: This is an observational study of patients with mild to severe keratoconus who have undergone epithelium-off CXL. CXL was completed by applying dextran-free riboflavin (0.1%) for 10 min (Vibex Rapid; Avedro, Inc.), followed by continuous UV-A light (Avedro KXL system; Avedro, Inc.) for 30 min at an intensity of 3 mW/cm2 and an energy of 5.4 J/cm2. All patients were prescribed postoperative proxymetacaine hydrochloride PRN with an allowed frequency of up to eight times per 24 h for the first 3 days to control postoperative pain. Patients were reviewed at 1–2 weeks postoperatively for a comprehensive examination, including assessment of delayed corneal healing, removal of the bandage contact lens, and recording of subjective symptoms. Results: There were 223 eyes of 180 patients with a mean age of 24.9 ± 8.6 years (range: 13–38 years). Male patients were 72%. At their planned first postoperative visit, we found no corneal healing abnormalities, such as persistent epithelial defects, epithelial irregularities, or early postoperative stromal haze, in any patient. All patients subjectively reported that proxymetacaine drops helped them to control postoperative pain, particularly in the first 48 h. Conclusions: None of the patients reported pain after 3 days of using proxymetacaine drops up to eight times a day for the first 3 days. It appears to be a safe and effective solution to control postoperative pain without any complications.

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CLINICAL RELEVANCE: Cycloplegic refraction remains crucial in young adults, where accommodative activity can obscure accurate refractive status. Autorefractor repeatability is essential for precise optical correction and refractive error categorisation in clinical and research settings. BACKGROUND: Cycloplegic autorefraction is recommended for individuals up to 20 years to prevent hyperopia underestimation and myopia overestimation. This study evaluated differences between non-cycloplegic and cycloplegic spherical equivalent refraction following cyclopentolate hydrochloride (cycloplegic agent) administration in young adults. This study also explored whether this difference varied by refractive status (hyperopia (≥1.00D), emmetropia ( >-0.50, <1.00D), myopia (≤-0.50D)) or pre-instillation of proxymetacaine hydrochloride and whether cycloplegia improved autorefractor repeatability. METHODS: Participants were 182 young adults (17-30 years) (mean (standard deviation): 21.66 (2.86) years). The right eye received 0.5% proxymetacaine hydrochloride and one (blue/green irides) or two drops (brown/hazel irides) of 1.0% cyclopentolate hydrochloride. The left eye received cyclopentolate hydrochloride only. Autorefraction was performed before and after cycloplegia. Analysis included paired t-testing, Deming regression, Bland-Altman analysis and equivalence testing. RESULTS: < 0.001) with 48.4% of participants exhibiting clinically significant differences of ≥ 0.50D. Agreement between non-cycloplegic and cycloplegic measurements was poor (limits of agreement: -0.71 D to +2.07 D, right eye). Hyperopes showed the greatest shift (1.39(0.91) D), compared to emmetropes (0.66(0.47) D) and myopes (0.31 (0.34) D). Cycloplegia improved repeatability, narrowing limits of agreement (-0.16 D to +0.15 D vs -0.24 D to +0.21 D). Proxymetacaine hydrochloride pre-instillation enhanced cycloplegic effect (+0.15 (0.07) D), particularly in hyperopic participants. CONCLUSIONS: A clinically significant difference was observed between non-cycloplegic and cycloplegic autorefraction in young adult participants, particularly among hyperopes. Cycloplegic measurements showed better repeatability, supporting their use for accurate refraction. Further research is needed on potential enhancing effects of proxymetacaine hydrochloride, particularly in diverse populations.

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PURPOSE: The primary sensory location of contact lens discomfort remains unclear. This study utilised selective topical anaesthesia of the ocular surface to investigate if the relative contribution of different tissues to lens-related discomfort could be determined. METHODS: This was a randomised, subject-masked, contralateral eye pilot study involving 10 participants. Mechanical sensitivity was measured at three locations on the ocular surface (cornea, upper and lower eyelid marginal conjunctiva) using a Cochet-Bonnet aesthesiometer. Following sensitivity measurements, proxymetacaine hydrochloride 0.5% was topically applied to one of the three locations in one eye whilst 0.9% saline was applied to the corresponding location in the fellow eye as a placebo. Sensitivity measurements were then repeated. A pair of rigid contact lenses was subsequently applied and comfort scores were recorded after 5 min using a 0-100 visual analogue scale. RESULTS: The sensitivity of the location anesthetised decreased significantly (all Bonferroni-adjusted p<0.006), whilst the sensitivity of the unanaesthetised remaining two locations showed no significant change (all p>0.05). There was no significant change in sensitivity following the application of saline (all p>0.05). There was no significant difference in comfort following lens application between the anaesthetic and saline for the cornea and lower lid marginal conjunctiva [LSM difference (95% CI): -3.0 (-11.3, 5.3) and 2.0 (-6.3, 10.3), respectively]. However, comfort was significantly better when the upper lid marginal conjunctiva was anaesthetised compared to saline application [12.3 (4.0, 20.6)]. CONCLUSION: This work has demonstrated a novel technique which can successfully selectively anaesthetise specific regions of the ocular surface. The initial comfort of rigid lenses was better when the upper lid marginal conjunctiva was anaesthetised, which supports the hypothesis that initial comfort of rigid lenses may be driven by the interaction between the lens and the upper eyelid. This work may also have significant utility for investigating discomfort in soft contact lenses.

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