International Ophthalmology

, Volume 35, Issue 2, pp 215–219 | Cite as

The change in intraocular pressure after pupillary dilation in eyes with pseudoexfoliation glaucoma, primary open angle glaucoma, and eyes of normal subjects

  • Eray Atalay
  • Nevbahar Tamçelik
  • Ceyhun Arici
  • Ahmet Özkök
  • Metin Dastan
Original Paper


To evaluate the change in intraocular pressure (IOP) after pharmacologic dilation in eyes with primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), and eyes of normal subjects. This cross-sectional study was conducted in a university hospital-based setting. Patients with PXG, POAG, and normal subjects were consecutively selected and included in the study. Of the 125 eyes of 125 subjects; 46 (25 female) had PXG, 42 (29 female) had POAG, and 37 (20 female) belonged to the control group. Pharmacologic dilation procedure consisted of instillation of topical phenylephrine HCL 10 % followed 5 min by tropicamide 1 %. Studied variables were pre- and post-dilation IOP and also baseline measurements of anterior chamber angle, central corneal thickness, and pupillary diameter by Pentacam HR (Oculus, Wetzlar, Germany). Clinically significant IOP change was defined as a change of ≥2 mmHg from baseline. Randomly selected single eye of each patient was included in the analysis. The mean pre:post-dilation IOP of eyes with PXG and POAG was 17.39 ± 3.89:17.54 ± 3.98 and 15.92 ± 2.37:16.07 ± 2.89 mmHg, respectively. The difference between the pre- and post-dilation IOP of eyes with PXG and POAG was not statistically significant. The eyes of control subjects, however, had a statistically significant reduction of IOP from 14.24 ± 2.88 to 13.54 ± 2.94 mmHg (P = 0.005). 28.3 % (13/46) of eyes with PXG, 16.7 % (7/42) of eyes with POAG, and 2.7 % (1/37) of control eyes showed a clinically significant IOP elevation from baseline after the dilation. In this study, glaucoma patients proportionally experienced a higher rate of clinically significant IOP elevation after pupillary dilation, when compared to normal subjects.


Pupillary dilation Mydriasis Pseudoexfoliation glaucoma Primary open angle glaucoma Tropicamide Phenylephrine 



The authors have no financial or proprietary interest to disclose.




  1. 1.
    Shaw BR, Lewis RA (1986) Intraocular pressure elevation after pupillary dilation in open angle glaucoma. Arch Ophthalmol 104:1185–1188CrossRefPubMedGoogle Scholar
  2. 2.
    Tan GS, Wong CY, Wong TY, Govindasamy CV, Wong EY, Yeo IY, Aung T (2009) Is routine pupil dilation safe among Asian patients with diabetes? Invest Ophthalmol Vis Sci 50:4110–4113CrossRefPubMedGoogle Scholar
  3. 3.
    Taner P, Unal B, Demirbaş E, Ergin A (2004) The effects of cyclopentolate on intraocular pressure and retrobulbar hemodynamics in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Eur J Ophthalmol 14:394–400PubMedGoogle Scholar
  4. 4.
    Shihadeh WA, Ritch R, Scharf B, Liebmann JM (2009) Delayed intraocular pressure elevation after pupillary dilation in exfoliation syndrome. Acta Ophthalmol 89:560–562CrossRefPubMedGoogle Scholar
  5. 5.
    Chen T (2005) Risk factors for intraocular pressure elevations after pupillary dilation in patients with open angles. Ann Ophthalmol 37:69–76CrossRefGoogle Scholar
  6. 6.
    Harris LS (1968) Cycloplegic-induced intraocular pressure elevations a study of normal and open-angle glaucomatous eyes. Arch Ophthalmol 79:242–246CrossRefPubMedGoogle Scholar
  7. 7.
    Razeghinejad MR, Pro MJ, Katz LJ (2011) Non-steroidal drug-induced glaucoma. Eye (Lond) 25:971–980CrossRefGoogle Scholar
  8. 8.
    Siam GA, de Barros DS, Gheith ME, Da Silva RS, Lankaranian D, Tittler EH, Myers JS, Spaeth GL (2007) The amount of intraocular pressure rise during pharmacological pupillary dilatation is an indicator of the likelihood of future progression of glaucoma. Br J Ophthalmol 91:1170–1172CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Valle O (1976) The cyclopentolate provocative test in suspected or untreated open-angle glaucoma. I. Effect on intraocular pressure. Acta Ophthalmol (Copenh) 54:456–472CrossRefGoogle Scholar
  10. 10.
    Ritch R, Schlötzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:265–315CrossRefPubMedGoogle Scholar
  11. 11.
    Kass MA (1996) Standardizing the measurement of intraocular pressure for clinical research. Guidelines from the Eye Care Technology Forum. Ophthalmology 103:183–185CrossRefPubMedGoogle Scholar
  12. 12.
    Musch DC, Gillespie BW, Niziol LM, Cashwell LF, Lichter PR, on behalf of the CIGTS Study Group (2008) Factors Associated with Intraocular Pressure Prior to and during 9 years of Treatment in the Collaborative Initial Glaucoma Treatment Study. Ophthalmology 115:927–933CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Weinreb RN, Brandt JD, Garway-Heath DF, Medeiros FA, Brandt J, Liu J (2007) IOP as a risk factor for glaucoma development and progression. In: Weinreb RN, Brandt JD, Garway-Heath DF, et al. (eds) Intraocular pressure: reports and consensus statements of the 4th Global AIGS Consensus meeting on intraocular pressure. WGA Consensus Series 4. Kugler, The Hague, p 59–74Google Scholar
  14. 14.
    Hancox J, Murdoch I, Parmar D (2002) Changes in intraocular pressure following diagnostic mydriasis with cyclopentolate 1 %. Eye 16:562–566CrossRefPubMedGoogle Scholar
  15. 15.
    Qian CX, Duperré J, Hassanaly S, Harissi-Dagher M (2012) Pre- versus post-dilation changes in intraocular pressure: their clinical significance. Can J Ophthalmol 47:448–452CrossRefPubMedGoogle Scholar
  16. 16.
    Kim JM, Park KH, Han SY, Kim KS, Kim DM, Kim TW, Caprioli J (2012) Changes in intraocular pressure after pharmacologic pupil dilation. BMC Ophthalmol 12:53CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Tsai IL, Tsai CY, Kuo LL, Liou SW, Lin S, Wang IJ (2012) Transient changes of intraocular pressure and anterior segment configuration after diagnostic mydriasis with 1 % tropicamide in children. Clin Exp Optom 95:166–172CrossRefPubMedGoogle Scholar
  18. 18.
    Valle O (1974) Effect of cyclopentolate on the aqueous dynamics in incipient or suspected open-angle glaucoma. Acta Ophthalmol Suppl 123:52–60PubMedGoogle Scholar
  19. 19.
    Kristensen P (1965) Mydriasis-induced pigment liberation in the anterior chamber associated with acute rise in intraocular pressure in open-angle glaucoma. Acta Ophthalmol (Copenh) 43:714–724CrossRefGoogle Scholar
  20. 20.
    Conway RM, Schlötzer-Schrehardt U, Küchle M, Naumann GO (2004) Pseudoexfoliation syndrome: pathological manifestations of relevance to intraocular surgery. Clin Experiment Ophthalmol 32:199–210CrossRefPubMedGoogle Scholar
  21. 21.
    Wiederholt M, Thieme H, Stumpff F (2000) The regulation of trabecular meshwork and ciliary muscle contractility. Prog Retin Eye Res 19:271–295CrossRefPubMedGoogle Scholar
  22. 22.
    Alm A, Nilsson SF (2009) Uveoscleral outflow: a review. Exp Eye Res 88:760–768CrossRefPubMedGoogle Scholar
  23. 23.
    Atalay E, Tamçelik N, Capar O (2013) High intraocular pressure after carbamazepine and gabapentin intake in a pseudoexfoliative patient. J Glaucoma. doi: 10.1097/IJG.0b013e318287aca7 Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Eray Atalay
    • 1
  • Nevbahar Tamçelik
    • 2
  • Ceyhun Arici
    • 2
  • Ahmet Özkök
    • 2
  • Metin Dastan
    • 1
  1. 1.Kars State HospitalKarsTurkey
  2. 2.Istanbul University Cerrahpasa Medical SchoolIstanbulTurkey

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