Mydriasis

Mydriasis, or pupillary dilation, is an ocular condition that can result from a variety of causes.

Mydriasis is characterized by an excessive opening of the pupil, often asymmetrically between the two eyes.  This dilation may be due to factors such as the deliberate use of mydriatic drugs, eye trauma, neurological disorders or underlying medical conditions. Mydriasis can also be pharmacologically induced for diagnostic purposes and to facilitate certain ophthalmic surgical procedures such as cataract surgery.

Diagnostic mydriasis

Mydriasis

In ophthalmological practice, mydriasis is often induced for diagnostic purposes. Pupil dilation enables ophthalmologists to examine in detail the internal structures of the eye, including the retina, macula and optic nerve. This in-depth evaluation is essential for the screening and diagnosis of various ocular pathologies.

By dilating the pupil, the ophthalmologist can better visualize the signs of diseases such as diabetic retinopathy, age-related macular degeneration (AMD), glaucoma and other retinal and macular conditions. This makes it possible to detect early abnormalities that might be invisible with a non-dilated pupil¹, ensuring rapid and appropriate intervention.

Mydriatic eye drops are commonly used to induce mydriasis for diagnostic purposes. Their administration enables a more accurate and comprehensive assessment of the patient's ocular health. In addition, well-controlled mydriasis helps minimize discomfort for the patient during the examination, making the diagnostic experience more efficient and less invasive.

Mydriasis in cataract surgery

Mydriasis

Mydriasis plays a crucial role in cataract surgery, providing optimal access to the lens. In cataract surgery, mydriasis is often achieved with mydriatic drugs or through alternative methods such as intracamerally and depot delivery systems. Topical mydriatic agents typically have sympathomimetic or anticholinergic properties (or both) and are frequently administered before and during cataract surgery to maintain adequate pupillary dilation². Controlled mydriasis, achieved with these drugs, remains a key element in the success of surgery and for minimizing complications². First, let’s deep dive into the disease of cataract and its management.

What is cataract?

cataract

Cataract is a common eye disease characterized by the clouding of the lens. The lens acts as a natural lens and is located inside the eye, behind the iris (the colored part of the eye). It is essential for vision and also for accommodation, which is the transition from distant vision to near vision. Cataract can also result from eye trauma (post-traumatic cataract), a preexisting eye condition (pigmentary retinopathy, history of eye surgery, etc.), treatment (corticosteroids, orbital radiotherapy, etc.), or a chronic disease like diabetes. It can also be congenital. Certain factors increase the risk of cataract, such as smoking, high alcohol consumption, and exposure to sunlight (ultraviolet rays)³.

Cataract is the world leading cause of blindness, with approximately 15.2 million cases that comprised 45% of global blindness⁴. When not treated in time, cataract can lead to vision loss. Cataract also remained the second leading cause of moderate and severe vision impairment in the world, with 78.8 million people⁴.

What are the symptoms of cataracts?

What are the symptoms of cataracts?

With age, the normally transparent crystalline lens becomes increasingly opaque. Light passing through this lens can no longer pass through and converge on the retina. Images and colors are no longer perceived correctly. Cataracts do not develop uniformly. It can manifest itself in one or both eyes (most often), mainly through blurred or blurred vision, accompanied by a progressive decline in vision that cannot be improved with glasses. 

Other symptoms⁶ may also appear, such as :

  • Vision that’s cloudy, blurry, foggy or filmy.

  • Changes in the way you see color (colors may look faded or not as vivid).

  • Sensitivity to bright sunlight, headlights or lamps.

  • Glare, including halos or streaks that form around lights.

  • Difficulty seeing at night.

  • Changes in your vision prescription, including near-slightness that gets worse.

  • Needing a brighter light to read.

  • Double vision.

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