Specifications

40 II For Camera Operators (Pullout section)
The EyePACS Handbook: Tools for Program Success
Pupil Dilation Protocol
Policy:
Patients will undergo pharmacological pupillary dilation with one drop per eye of 1%
tropicamide solution when retinal images are of insufficient quality for interpretation
and no risk factors exist for complications from pupillary dilation.
Background:
Approximately 10% of images that are acquired without pupillary dilation with
non-mydriatic retinal cameras cannot be appropriately interpreted by clinicians due to
poor image quality. Two factors that affect image quality are small pupil size and media
opacities, such as cataracts. These limitations can be overcome by temporarily
increasing the pupil size with pharmacological agents. Better images can be acquired
more quickly when pupils are dilated, particularly in older patients, since they are more
likely to have small pupils and media opacities. Pharmacological dilation, however, can
have adverse effects.
The most common adverse effects are photophobia (sensitivity to light) and cycloplegia
(inability to change focus, usually causing near blur). Other adverse effects are much
less common, and include hypersensitivity, which can cause conjunctival and corneal
inflammation and ocular infection from contact with contaminated eye drops. Pupillary
dilation has occasionally been reported to cause acute angle closure glaucoma, a
painful sight-threatening condition. The use of two dilating agents used in combination
for full pupillary dilation have been reported to potentially cause angle closure in
approximately one out of five thousand individuals. There have been no reported cases
of angle closure caused by using a single dilating agent. One drop per eye of 1%
tropicamide can be used as a single agent to provide adequate dilation for retinal
photography. Onset of pupillary dilation is approximately 15 minutes and photophobia
and cycloplegia will typically last from two to four hours, although rare individuals may
experience pupil dilation for up to three days.
Procedure:
In the event that adequate images cannot be acquired without pupillary dilation, please
follow the following steps:
1. Photographer or qualified health care personnel determines that patient does
not:
a. have a personal history of glaucoma;
b. have significant redness, irritation, or discharge from eyes;
c. is not pregnant;
d. is not wearing contact lenses; and
e. has not had a previous adverse reaction to pupillary dilation