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Systematic review of mydriatics used for screening of retinopathy in premature infants
  1. Lisa Jean Kremer1,2,
  2. David M Reith2,
  3. Natalie Medlicott1,
  4. Roland Broadbent2
  1. 1 School of Pharmacy, University of Otago, Dunedin, Otago, New Zealand
  2. 2 Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
  1. Correspondence to Lisa Jean Kremer; lisa.kremer{at}


Introduction Routine retinopathy of prematurity eye examinations are an important part of neonatal care, and mydriatic medicines are essential in dilating the pupil for the eye examination. There are concerns about the level of evidence for efficacy and safety of these mydriatic medicines.

Objective This review evaluates both efficacy and safety evidence of mydriatics used during the retinopathy of prematurity eye examination.

Method Systematic literature review.

Results There is limited evidence guiding clinical practice for safety and efficacy of mydriatics. The majority of publications are underpowered and with an unclear to high level of bias. There are a wide variety of mydriatic regimens evaluated for efficacy and safety, and multiple regimens are associated with case reports.

Conclusions Current international guideline seems unnecessarily high, especially when the reviewed literature suggest that lower doses are effective, albiet from underpowered studies. The lowest effective combination regimen appears to be phenylephrine 1% and cyclopentolate 0.2% (1 drop). Microdrop administration of this regimen would further increase the safety profile, however, efficacy needs to be assessed.

  • neonate
  • retinopathy of prematurity
  • mydriatic
  • phenylephrine
  • cyclopentolate
  • tropicamide

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  • Contributors RB suggested the topic for the review. LK carried out the review, planned the structure of the article and conducted the systematic review and wrote the article. RB, DR and NM provided comments, supervision and support throughout.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in the submitted article are our own and not an official position of the institution.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.

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