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Cycloplegic retinoscopy
- 2. CYCLOPLEGIC RETINOSCOPY • Cycloplegic retinoscopy is a procedure used to determine a patient’s complete refractive error by temporarily paralyzing the ciliary muscle by cycloplegic drugs. • Often called Wet retinoscopy
- 3. COMMONLY USED CYCLOPLEGICS ● Atropine (1.00D) ● Homatropine (0.50D) ● Cyclopentolate (0.75D) ● Tropicamide (0.50D)
- 4. INDICATIONS ● Young children ● Child- uncooperative with dry retinoscopy ● Excessive accommodation ● Pseudo myopia ● Strabismus ● Asthenopic symptoms
- 5. OTHER INDICATIONS ● For all children, at least once to determine their baseline error ● Whenever refraction yields variable results at any age but usually below 50 ● In pre or early presbyopia when glasses have not been previously worn ● In bilateral refractive asymmetry or whenever a good binocular balance of the refractive correction can not be achieved ● For obvious or suspected EOM imbalance
- 6. CONTRA INDICATIONS ● Absence of patient’s consent ● Conjunctival hyperaemia ● Birth history* ● -incubation box ● -convulsion ● -allergy ● -high fever ● History of Angle closure attacks (glaucoma) ● Anatomically shallow AC angle ● IOP
- 7. THINGS TO BE CONSIDERED TO PATIENT BEFORE PERFORMING CYCLOPLEGIC REFRACTION ● Duration of the procedure ● Blurred vision ● Photophobia and its duration (dependent on the drug - dosage) ● Advise Not to drive ● Advise not to operate any moving machinery ● Advice parent / guardian / carer to be with the patient as vision is blur
- 8. PREREQUISITES ● Cycloplegic drugs ● A semi dark room ● A trial box ● Snellen’s self illuminated vision box ● A retinoscope
- 9. PROCEDURE ● Room illumination is semi dark • Ask pt. to fixate the target • Eye level of both examiner and patient should be on same height • Perform the retinoscopy
- 10. PRECAUTIONS SHOULD BE TAKEN BY EXAMINER WHILE PERFORMING RETINOSCOPY ● Body posture ● Sitting position ● Height ● Handling Retinoscope ● 1 hand distance
- 11. WITH MOVEMENT
- 12. AGAINST MOVEMENT
- 14. HOW TO NEUTRAL REFLEX
- 17. FINAL CYCLOPLEGIC RETINOSCOPIC VALUE • Amount of refractive error = retinoscopic findings – deduct WD – tonus allowance for cycloplegic drug used
- 18. ADVANTAGES • Firm base for objective refraction • Helpful in Esotropia and convergence excess • Helpful in Accommodative spasm • Very helpful in uncooperative children
- 19. DISADVANTAGES • Temporary symptoms of blurred vision and photophobia • The degradation of vision is of the accommodation response and increase in ocular aberrations as a result of dilated pupils.
- 20. SOME SEVERE DISADVANTAGES • severe reactions such as 1. Psychosis 2. Hallucinations 3. Ataxia 4. incoherent
- 22. FOLLOW UP VISIT • CTC – after 3 days • HTH – after 7 days • ATROPINE – AFTER 21 DAYS
- 23. REFERENCES • Primary Care optometry • Fine are of prescribing glasses • Comprehensive ophthalmology- A.k. khurana • Optics and refraction –A.k. khurana
- 24. THANK YOU
Editor's Notes
- Generally cycloplegic retinoscopy is used when examiner suspects that accommodation is abnormally active and will hinder the exact retinoscopy
- Ctc 0.75 Hth 0.50
- USUALLY CR IS PERFORMED IN YOUNG CHILDREN
- ( as pt. is illiterate, bedfast or anesthetized)
- Drug hypersensitivity History of angle closure attacks
- Cycloplegic refraction offers the clinician a firm base for objective refraction
- PSYCHOSIS
- Psychosis( a severe mental disorder in which thoughts and emotions are so impaired Hallucinations(an experience involving the apparent perception of something not present) Ataxia (impaired coordination ) incoherent (confused or something difficult to understand)