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Dilating drops recommended for fundus examination for abusive head injury (shaken baby syndrome)

Dilating drops recommended for fundus examination for abusive head injury (shaken baby syndrome)
Name Efficacy/advantages Duration of large pupil* Disadvantages
Tropicamide 1/2 or 1% Good in less pigmented eyes 4 to 6 hours Works less well in brown eyes
Cyclopentolate 1/2 or 1% (do not use 1% concentration in infants <6 months or children with epilepsy) Good in all eyes 1 to 2 days

Long duration

2% solution can cause hallucinations
Phenylephrine 2.5%

Poor by itself

Very helpful combined with tropicamide or cyclopentolate
3 to 4 hours

Systemic hypertension in higher strengths

Used alone, pupil still constricts during examination
Cyclomydril (0.2% cyclopentolate and 1% phenylephrine, Alcon Laboratories)

Good in less pigmented eyes

Commonly used for ROP examinations

Convenient combination drop
3 to 4 hours Often needs to be repeated for darker eyes

ROP: retinopathy of prematurity.

* Repeat dosage will prolong duration by up to 50%.
Reproduced with permission from: Kivlin JD. Ophthalmic manifestations of shaken baby syndrome. Journal of Aggression, Maltreatment & Trauma 2001; 5:137. © 2001 The Haworth Press, Inc.
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