CFII - Cycloplegic Refraction

What is dry refraction?

Refraction performed without drops under natural accommodative conditions.

What is damp refraction?

Refraction using tropicamide causing partial cycloplegia.

What is wet refraction?

Refraction using cycloplegic agents causing full cycloplegia.

What do cycloplegics do?

Paralyze accommodation and dilate the pupil.

What are examples of cycloplegic agents?

Atropine, homatropine, scopolamine, cyclopentolate, tropicamide.

What are the mydriatic effects of cycloplegics?

Pupil dilation and increased light sensitivity (photophobia).

What are the cycloplegic effects of cycloplegics?

Paralysis of the ciliary muscle, loss of accommodation, and difficulty with near tasks.

What does cyclopentolate do?

Causes mydriasis and cycloplegia.

When was cyclopentolate introduced into clinical practice?

1951.

How does cyclopentolate perform in darker irides?

Less effective mydriatic.

How does iris color affect cycloplegia onset and recovery?

Faster onset and recovery in light eyes than dark eyes.

What is the maximum time for cyclopentolate mydriasis?

20–45 minutes.

What is the recovery time for cyclopentolate mydriasis?

1 day.

What is the maximum time for cyclopentolate cycloplegia?

20–45 minutes.

What is the recovery time for cyclopentolate cycloplegia?

0.25–1 day.

What is the drug of choice for cycloplegic refraction?

Cyclopentolate.

Why is cyclopentolate preferred?

Better cycloplegic effect than homatropine and similar to atropine with faster onset and shorter duration.

When is cyclopentolate especially used?

In infants and young children.

What condition can cyclopentolate be used to treat?

Anterior uveitis.

When is cyclopentolate useful compared to atropine?

When patients are sensitive to atropine.

What is the purpose of cycloplegic refraction?

Measure refractive error without accommodation.

How does cycloplegic refraction eliminate accommodative interference?

By paralyzing the ciliary body.

What are clinical indications for cycloplegic refraction?

Pediatric exams, latent hyperopia, accommodative esotropia/strabismus, suspected accommodative spasm, VA mismatch with objective findings.

What must be considered before instilling eye drops?

Contraindications, side effects, and patient status.

What are examples of contraindications?

Pregnancy, nursing, and allergies.

What consent is required for pediatric patients?

Parental or guardian consent.

What equipment is needed for cycloplegic refraction?

Retinoscope, phoropter or trial frame, visual acuity chart, optional topical anesthetic, and cycloplegic agents.

What is the most commonly used cycloplegic agent in clinic?

Cyclopentolate.

What concentration of cyclopentolate is standard for patients older than 2 years?

1%.

What concentration of cyclopentolate is used for infants?

0.5%.

Why is atropine less commonly used?

Safety concerns despite strong cycloplegia.

What is an alternative cycloplegic regimen?

Tropicamide + phenylephrine + cyclopentolate.

What steps are included before cycloplegia in the procedure?

Visual acuity, entrance testing, anterior segment and angle assessment, intraocular pressure, and dry retinoscopy/refraction.

What patient history must be reviewed before cycloplegia?

Medications, allergies, pregnancy, and breastfeeding.

When is cycloplegia performed in adults?

After non-cycloplegic refraction.

What must always be done before cycloplegia in children?

Non-cycloplegic retinoscopy.

What optional drop can be used before cycloplegics?

Proparacaine 0.5%.

What type of drug is proparacaine?

Topical anesthetic.

What is the purpose of proparacaine?

Numbs ocular surface, reduces stinging, improves comfort and cooperation.

What is the drop protocol for cyclopentolate?

1–2 drops separated by 5 minutes in both eyes.

What determines cyclopentolate drop strength?

Patient age.

How long does full cycloplegia and mydriasis take?

Approximately 30 minutes.

How can cycloplegia be confirmed?

Push-up accommodation test and retinoscopy reflex.

What is done after cycloplegia is confirmed?

Perform retinoscopy.

How is cycloplegic retinoscopy performed?

Same as standard retinoscopy.

Who should always receive cycloplegic retinoscopy?

All children.

What additional tool may be used in fast-paced settings?

Autorefractor.

When is monocular subjective refraction performed under cycloplegia?

If indicated and patient can cooperate.

What abilities are required for subjective refraction?

Reliable responses and sustained attention.

What must always be documented after cycloplegic refraction?

Drug name, concentration, number of drops, and time administered.

What is an example of documentation for cycloplegic drops?

2 gtts cyclopentolate 1% OD/OS at 1:00 PM.

What does cycloplegic retinoscopy measure?

Refractive error under cycloplegia.

What does cycloplegic refraction determine?

Final refractive prescription under cycloplegia.

What is a key principle of cycloplegia findings?

Cycloplegia reveals true refractive error.

Why is cycloplegic refraction essential in pediatric patients?

Eliminates accommodation to reveal accurate refractive error.

What happens to refraction under cycloplegia compared to dry refraction?

More plus (+) is found.

In which conditions is more plus seen under cycloplegia?

Latent hyperopia, accommodative spasm, and pediatric patients.

What must always be ensured when performing cycloplegic refraction?

Safety, documentation, and consent.