Neurotoxic Effects of Topical Cyclopentolate

The Influence of Topical Cyclopentolate Instillation on Peripapillary and Macular Microvasculature Measured by Optical Coherence Tomography Angiography in Healthy Individuals

“…12 13 14 15 16 17 Systemic absorption of the drug can occur transconjunctivally or by entering the nasolacrimal duct through highly vascular nasal mucosa. 17 18 19 20 21 Furthermore, after topical use, the drug can spread across the globe, and a direct effect through the retinal capillaries can be observed. 21 Systemic toxicity of cycloplegics is dose related.…”

“…Although uncommon, cycloplegics may induce mental and neurotoxic effects such as drowsiness, ataxia, visual hallucinations, tachycardia, restlessness, psychosis, hyperactivity, seizures, and incoherent speech. 17 18 19 20 21 Muscarinic cholinoceptors were occupied almost completely (more than 99.9%) by aqueous humor and 3%–18% by plasma taken at 55–125 min after the drug application. 18 In another study, its cycloplegic effects begin at 25–75 min after administration of the drop and recovery appears through 6–24 h later.…”

Characterizing Current Attitudes and Practices for Human Subject Safety in Studies Involving Pupil Dilation

“…This results in caution or avoidance for clinical use in individuals predisposed to systemic cardiovascular effects, such as those with cardiovascular disease and thyrotoxicosis (Coulter et al, 2008; Lai, 1989; Nevitt, 2013; Paragon BioTeck Inc, 2014). For the antimuscarinic mydriatic cyclopentolate, significant adverse effects including, but not limited to ataxia, drowsiness, incoherent speech, seizures, and hallucinations have been reported with topical use, especially with children (Bausch & Lomb Incorporated, 2016; Mirshahi & Kohnen, 2003; Rajeev et al, 2010; Wakayama et al, 2018). Tropicamide has also been reported to cause effects including but not limited to central nervous system disturbances, psychotic reactions and vasomotor or cardiorespiratory collapse, but with less propensity than cyclopentolate (Bausch & Lomb Incorporated, 2019; van Minderhout et al, 2015; Vuori et al, 1994).…”

The Misuse and Abuse of Ophthalmic Preparations: a Scoping Review of Clinical Case Presentations and Extant Literature

“…Drug induced toxicity in the case of abuse of cycloplegic and mydriatic ophthalmic drugs contribute to keratitis with some reports around withdrawal symptomatologies and difficulties in the treatment of dependence (Ostler 1975;Sato et al 1992;Akkaya 2008;Darcin et al 2011). Cyclopentolate systemic side effects reported in the literature range from inappropriate behaviour, visual and auditory hallucinations, changes in emotional attitude, and generalized seizures to a lesser extent (Rajeev et al 2010;Bhatia et al 2000). Cognitive impairment and weight loss are common (Bersini et al 2015).…”