Cycloplegic Efficacy Of Cyclopentolate Ointment vs. Cyclopentolate Solution.

Cycloplegic examinations are the standard of care for children. They are used to determine the full amount of prescription a child has, without the concern for their high accommodative capabilities to result in under-corrected refractive error. Baseline refractive error is important in preventing and treating amblyopia and other binocular deficits. Eye drops have been the historical modality of instilling cycloplegics, but these cause considerable discomfort for children which can disrupt the exam and create an unwilling patient. Ophthalmic ointments have been found to be more comfortable upon instillation than equivalent ophthalmic drops (Cable). Cyclopentolate hydrochloride is considered to be the medication of choice for determining cycloplegic refractive error but is only available from pharmaceutical distributors in solution form (Manny). This study will investigate if the compounded ointment form has an equivalent cycloplegic effect when compared to the solution form, as measured by autorefraction, and whether the added cost of obtaining the medication in ointment form is justified by improved patient comfort and facility of the exam. The ointment form would offer better patient cooperation and less disruption to examinations. This would help in sensitive patients or children who respond so negatively to the stinging of drops, as well as in the disabled or patients who are unable to lift their head for drops. Due to the irritating nature of
preservatives, increased lacrimation washes out some of the drug, yielding a decreased
amount of drug penetrating the cornea (Ismail). Drops generally are not well retained in
the eye, but are squeezed or drained out through the nasolacrimal duct (Goodman). It has
been reported that ointments are equally, or more, effective than topical drops in solution
or liquid suspension form, and they cause less irritation and require less amounts of the drug (Cable). The side effects of drugs in ointment are the same as equivalent drugs in drop form because ointments have the same systemic absorption (Fiscella, Scruggs).