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Problems post-tropicamide/proparacaine
I had an ocular exam last Friday- eyes were dilated with tropicamide and proparacaine. Prior to this I have not had any vision problems, never worn glasses or contacts. This visit I was concerned with some minor blurriness at night and the optometrist said I needed glasses just for driving/distance vision (OD-0.25, )S-0.5). After the exam had blurred vision, sensitive to light (assumed initially just due to dilation) and then marked swelling of conjunctiva, eyes extremely pruritic, eyelids swollen. Saturday was worse but pupils normal. Seen on Sunday and diagnosed with allergic reaction either to the tropicamide or proparacaine and Rx'd PATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% SID. Vision still blurry, eyes still not normal so seen again on Monday and she Rx'd Alrex (loteprednol etabonate ophthalmic suspension 0.2%) QID. Eyes less itchy but far vision still much worse/blurry than before exam and headaches whenever I try to wear the glasses. I go back for another exam on Saturday but am concerned about long term effects. Would you recommend seeing an ophthalmologist rather than continued exams with optometrist? Any Ddx ideas other than allergic reaction? Thank you in advance.
You might be sensitive to tropicamide or you could have really dried your corneas out (proparacaine dryes the cornea).
The way we handle this in our office we use Fluress to check the IOP (it numbs the eye) we use 0.5% (half strength) tropicamide and 2.5% neosynephrine, have the person blind frequently during and after the exam, be careful not to rub the eye with finger or kleenex. We instill an artifical tear and a couple of drops of pred forte before the person leaves and give them a sample of artificial tears to use every half hour for four hours after the exam. That usually works.
I do have one patient that I gave a bottle of pred forte and she uses it 4 times per day for two days after I examine her.
The way we handle this in our office we use Fluress to check the IOP (it numbs the eye) we use 0.5% (half strength) tropicamide and 2.5% neosynephrine, have the person blind frequently during and after the exam, be careful not to rub the eye with finger or kleenex. We instill an artifical tear and a couple of drops of pred forte before the person leaves and give them a sample of artificial tears to use every half hour for four hours after the exam. That usually works.
I do have one patient that I gave a bottle of pred forte and she uses it 4 times per day for two days after I examine her.
Similar problem. Seen by neuro-ophthalmologist. Anesthetic drops and dilation drops applied. Effects worsened as the hours increased after dilation. Disabling blurred vision and photosensitivity for six days, along with dull ache in R eye, feeling of fullness/pressure in R eye, which continues, somewhat abated on day 8. Had revisit today. L eye refraction significantly down. I was advised to use artificial tears. No anomalies other than both cataracts, (which are mild), seen on re-exam. MD says there is nothing more she can do for me, and she would have to refer me elsewhere. If a neuro-ophthalmologist can't do anything, who, I wonder will. She said she didn't think I was imagining it all.
This has nothing to do with the doctor being an optometrist or an ophthalmologist. To suggest so is unprofessional and inappropriate. You had an obvious allergic reaction to the proparacaine and were treated properly. In terms of the glasses, your complaint with night driving does suggest that mild myopic correction could be helpful.
MEDICAL PROFESSIONAL
Yes add artifical tears and try warm compresses to closed lids.
JCH MD
JCH MD
Thank you so much for the information, so glad I paid 350$ for the glasses! I will make an appointment with an ophthalmologist as soon as possible. As it is Friday, any advise on whether to continue the medications prescribed until I can get an appointment, my eyes are still really bothering me. Should I add artificial tears?
MEDICAL PROFESSIONAL
Ditch the optometrist and see an Eye MD ophthalmologist. Those glasses by the way are extremely weak and think twice before paying $300-400 for lens that are almost window glass. Find an Eye MD near you at www.aao.org
You might be sensitive to tropicamide or you could have really dried your corneas out (proparacaine dryes the cornea).
The way we handle this in our office we use Fluress to check the IOP (it numbs the eye) we use 0.5% (half strength) tropicamide and 2.5% neosynephrine, have the person blind frequently during and after the exam, be careful not to rub the eye with finger or kleenex. We instill an artifical tear and a couple of drops of pred forte before the person leaves and give them a sample of artificial tears to use every half hour for four hours after the exam. That usually works.
I do have one patient that I gave a bottle of pred forte and she uses it 4 times per day for two days after I examine her.
JCH MD
You might be sensitive to tropicamide or you could have really dried your corneas out (proparacaine dryes the cornea).
The way we handle this in our office we use Fluress to check the IOP (it numbs the eye) we use 0.5% (half strength) tropicamide and 2.5% neosynephrine, have the person blind frequently during and after the exam, be careful not to rub the eye with finger or kleenex. We instill an artifical tear and a couple of drops of pred forte before the person leaves and give them a sample of artificial tears to use every half hour for four hours after the exam. That usually works.
I do have one patient that I gave a bottle of pred forte and she uses it 4 times per day for two days after I examine her.
JCH MD
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