Who Why & When (do we dilate)

“Do I Need Drops?”

It’s the one question we are guaranteed to be asked everyday – mostly by nervous children who’s memory serves them well. That one little drop can pack quite a punch and it’s momentary sting is often recalled by our younger patients on their return visits. It isn’t a surprise then that we are also asked by the parents of these children whether the drops really are necessary, in the hope of avoiding any dramatic displays in the consulting room!

 Why do we dilate Pupils?

It has been said that an un-dilated eye exam – particularly in children – can be likened to taking your car to the mechanic but not letting them look under the bonnet at the engine! It is essential for several reasons:

1. Accurate assessment of a child’s refraction

Refractive error is just one potential cause of blurred vision in a child & a Cycloplegic refraction is an objective & most accurate assessment of refractive error / prescription of the eye in young children. Children have a great ability to vary their accommodation or ‘auto focus’ so it is important we temporarily turn off the eye’s ability to accommodate which could otherwise mask that person’s true prescription.

2. Thorough assessment of the back of the eye

To properly & accurately assess the retina we need to dilate the pupil to create an open window with which to view all of the structures at the back of the eye. These structures include the optic nerve, macula & surrounding blood vessels & they are each responsible for good vision & a healthy eye. If not dilated, the iris, a sphincter muscle, will contract or ‘close’ making the window looking into the retina very narrow, thus restricting the view.

Who & When do we dilate?

In general, we need to use dilating drops on all new patients under the age of 10. Each doctor may have a slightly different approach however each patient will usually require dilating drops at least every 12-24 months depending on their age. We routinely see our younger patients every 6 months so unless specified we would organise to dilate these patients every alternate appointment unless we find an unexpected drop in vision or if there are any changes noted by the parent or Orthoptist. This will always be discussed with the patient prior to the drops being used.

Of course there are some eye conditions & presenting symptoms that contraindicate having the pupils dilated & in these cases our Orthoptist will always check with the Ophthalmologist if there are any concerns or queries regarding this.

“But they really sting!”

All of the drops available to dilate pupils carry a stinging sensation that lasts about 15 seconds. In our experience, instilling drops into a baby or child’s eyes can range between a relatively quick & stress free process to a rather traumatic & unpleasant one (for all involved!). At SOS we completely understand the anxiety a lot of our younger patients feel towards having these drops in their eyes, and with the help of mum & dad we will always try to make it as quick & stress free as possible – fun even!

Often the blurry light sensitive eyes that we leave you with will last several hours however many of our young patients will still be fine to return to school or day care. It is worth mentioning to the teacher / carer that your child’s pupils have been dilated & so reading small print will be difficult & that their eyes will be sensitive to glare for a few hours. We recommend bringing a pair of sunglasses for your child to wear after they leave our clinic to help with the sensitivity to glare.

SO! The next time we see you at Sydney Ophthalmic Specialists we MIGHT need to pop those unpleasant drops in you or your child’s eyes…so we hope that this clears up any queries you might have as to WHY we need to do that.