Title :

Effects of Tropicamide and Phenylephrine on Iris Dilation and Blood

Pressure in Adults with and Without Hypertension

Nurzalena

012018020795

FACULTY HEALTH LIFE AND SCIENCE

MANAGEMENT AND SCIENCE UNIVERSITY

2019
 JOURNAL

Abstract

Purpose: To investigate the effect of common dilating eye drops used for eye examination on
systemic blood pressure (BP) in adults, and how this may interact with history of
hypertension and associated medication use. The formulations examined, tropicamide 1% (T)
and tropicamide 1% & phenylephrine 2.5% (T+P), are used in eye care settings the world
over yet their systemic effects are not well documented.

Methods: In this prospective randomized study, patients received a single dose of either T or
T+P. Immediately prior to instillation of drops, an automated cuff obtained baseline BP and
pupil size was measured by slit lamp exam. A second reading was obtained 30 minutes after
drops were given. Direct patient questioning and chart review were used to gather medication
and medical history data.

Results: 104 patients were included. Mean age was 52.89±15.15 (mean±SD) years, 59.6% of
patients were females, 18.3% Caucasian, 43.3% African American, 25%% Hispanic, 3.8%
Asian. For the first analysis, patients were divided into two groups based on the dilating agent
they received: T, or T+P. Overall, average BP did not change from baseline; mean arterial
pressure (MAP) before dilation was 96.62±13.3mmHg and 96.8±12.67mmHg after dilation
(p =0.8). Those receiving T+P exhibited greater pupillary dilatation than T alone, (3.67 mm
vs. 4.26mm, p=0.02). This is attributable only to treatment effect, since baseline pupil sizes
did not differ between T and T+P groups (p=0.9), yet pupil sizes 30 minutes after drop
instillation were greater for T+P (6.91mm±1.19mm) than for T alone (6.33mm±0.93mm)
(p=0.009). Next, patients were divided into those diagnosed with hypertension (HTN) and
those without history of HTN (non-HTN). 93.7% of patients with HTN were on
antihypertensive medications at the time of visit. Changes from baseline in MAP, systolic BP,
diastolic BP, heart rate, and pupil size were compared between HTN and non-HTN groups.
HTN patients’ pupils dilated to a greater extent in response to T+P (+4.09±0.98mm) than T
alone (+3.35mm±0.98mm) (p=0.03). No other significant changes from baseline in the above
parameters were found between HTN and non-HTN groups.

Conclusions: Dilating eye drops containing T+P exert a stronger mydriatic effect than T
alone, especially in hypertensive patients undergoing antihypertensive therapy. Neither
formulation appears to affect systemic blood pressure or heart rate.
Application of biochemistry :

Tropicamide chemical properties is crystalline solid. Its a parasympatholytic agent,

which acts by blocking the action of the parasympathetic nervous system. As
acetylcholine is the neuro-humoral transmitter at the receptor site of the
parasympathetic nervous system, tropicamide competes with acetylcholine for uptake
at the receptor sites, thereby blocking its action. The results are mydriasis, due to
unopposed action of the dilator pupillae, and cycloplegia.

Minims phenylephrine hydrochloride are single-use preservative-free eye drops

that contain the active ingredient phenylephrine. This is a type of medicine called
a sympathomimetic. It is also known as a mydriatic, which means it dilates the
pupil. Phenylephrine works by acting on alpha receptors on the muscle in the eye
that dilates the pupil. This causes this muscle to contract, which makes the pupil
open up or dilate.

Format Article Review

Title : Effects of Tropicamide and Phenylephrine on Iris

Dilatation and Blood Pressure in Adults with and
without Hypertension

Author Julian Tokerev,Elena Bitrian, Richard Manka

Years June 2013, Vol.54, 892. doi:

Journal of Investigative Ophthalmology & Visual

Science
Literature Review : Phenylephrine, a sympathomimetic drug, stimulates
the iris dilator muscle whereas parasympatholytic
drugs such as tropicamide, cyclopentolate or
atropine inhibit the iris constrictor muscle
(Martindale 2009). An ideal dilation regimen should
probably combine both sympathomimetic and
parasympatholyttic eyedrops.in this article wanted to
asess the efficacy of the combination tropicamide
1% Tropicamide and Tropicamide 1% and
Phenylephrine 2.5% (T+P) therefore performed a
prospective,randomized study that patients received
a single dose of either Tropicamide or
Tropicamide+Phenylephrine.

Purpose : To investigate the effects of eye drops used on

patients who have systemic blood pressure (BP) and
also the effect of relationships on hypetension or
non-hypertensive patients.

Methodology : In this prospective randomized study . The design

experiment used in this journal involved 104
patients. Direct patients and questioning and chart
review were used to gather medication and medical
history data.

Results The results shawed that indeed those who received

Tropicamide + Phenylephrine showed greater
pupillary dilatation than Tropicaamide alone.
likewise the results shown in hypertension patients
(HTN) widen to a greater extent in the Tropicamide
+ Phenylephrine agreement of T itself.
Conclucion : The conclusion in the study of this article is that
diating containing Tropicamide + Phenylephrine
provides a stronger mydriatic effect than
Tropicamide and the results show that the use of eye
drops Tropicamide and Phenylephrine does not
affect blood pressure and heart rate