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NeoReviews Vol.4 No.6 2003 e163
© 2003 American Academy of Pediatrics

Article

Pharmacology Review

Topical Mydriatics: The Adverse Effects of Screening Examinations for Retinopathy of Prematurity

Thomas E. Young, MD

Clinical Professor of Pediatrics, University of North Carolina, Chapel Hill, NC

The first 300 words of the full text of this article appear below.


   Introduction
 
The American Academy of Pediatrics, in a joint statement with the American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Ophthalmology, recommends that all infants who have birthweights less than 1,500 g or gestational ages of 28 weeks or less, as well as selected infants whose birthweights are between 1,500 and 2,000 g and who have unstable clinical courses should receive fundus examinations after pupillary dilatation to evaluate for retinopathy of prematurity (ROP). Most infants have at least two examinations. Despite more than 100,000 examinations being performed annually on preterm infants, there are relatively few data regarding the frequency and severity of adverse systemic effects caused by the examination or the medications used for the examination.


   The Oculocardiac Reflex
 
Ocular stimulation causes alterations in cardiac rhythm or rate via afferent impulses through the ophthalmic division of the trigeminal nerve via the reticular formation to the visceral motor nuclei of the vagus nerve. Traction on the ocular muscles and pressure on the globe are among the stimuli that cause bradycardia and ectopic beats in some patients. Clarke and associates documented positive oculocardiac reflexes in 17 of 54 preterm infants (31%) undergoing ophthalmoscopic screening examinations for ROP. Instillation of eye drops, introduction of the speculum, scleral depression, and traction on the rectus muscles all were associated with heart rate decreases of greater than 10%. All episodes lasted fewer than 15 seconds after removal of the stimulus. Ramet and colleagues demonstrated that the heart rate response to ocular pressure progressively increased with decreasing postconceptional age; infants at 32 weeks’ postmenstrual age (PMA) demonstrated electrocardiographic RR interval prolongation that was two to three times greater than infants at term PMA and older. A later study by the same authors demonstrated that RR interval prolongation induced by ocular stimuli during REM sleep was significantly greater . . . [Full Text of this Article]


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