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Evaluating hearing in newborns and uncooperative patients can pose a considerable challenge. One potential solution might be to employ the Pupil Dilation Response (PDR) as an objective physiological metric. In this dataset descriptor paper, we present a collection of data showing changes in pupil dimension and shape upon presentation of auditory stimuli. In particular, we collected pupil data from 16 subjects, with no known hearing loss, upon different lighting conditions, measured in response to a series of 60–100 audible tones, all of the same frequency and amplitude, which may serve to further investigate any relationship between hearing capabilities and PDRs. Dataset: Data is available at https://zenodo.org/doi/10.5281/zenodo.10497437. Dataset License: CC-BY-4.0 [ABSTRACT FROM AUTHOR]

Evaluating hearing in newborns and uncooperative patients can pose a considerable challenge. One potential solution might be to employ the Pupil Dilation Response (PDR) as an objective physiological metric. In this dataset descriptor paper, we present a collection of data showing changes in pupil dimension and shape upon presentation of auditory stimuli. In particular, we collected pupil data from 16 subjects, with no known hearing loss, upon different lighting conditions, measured in response to a series of 60–100 audible tones, all of the same frequency and amplitude, which may serve to further investigate any relationship between hearing capabilities and PDRs.

Abstract Purpose To compare 6 methods for intraoperative pupil dilatation in eyes with insufficient pupil size during phacoemulsification. Methods This was a prospective case–control study. 99 microcoria cataract patients (120 eyes) were collected and were divided into 6 groups(20 eyes each group), and their pupils were dilated by bimanual stretching pupil (group I), pupil radial cut open(group II), mechanical pupil dilatation with iris-retractor hooks (group III), OASIS iris expander (group IV), and Malyguin-ring (Microsurgical company, America) (group V), B-HEX Pupil Expander (Med Invent Devics, India)(group VI),respectively. 3.0 mm clear corneal incision were used in phacoemulsification. All cases were followed up at 1 week and 1, 3, 6 months after the surgery. The best corrected visual acuity (BCVA), intraocular pressure(IOP), corneal endothelium cell density(ECD), pupil diameter(PD) of before and after surgery were compared. Results One same doctor finished all cataract surgeries successfully. The eyes’ condition before surgery and at 6 months after surgery were compared. There were no significant statistical differences for the conditions of the eyes before surgery among six groups. The ECDs were better at 6 months postoperatively in group III and V, median values: 2114/mm2, 1961/mm2. PD was largest in group II (median value: 5.5 mm), which was significantly larger than other groups (Padjusted

Background: Mydriatic drugs are often used in ophthalmic clinics for pupil dilatation to assess the optic nerve and retina. Clinical studies have indicated that an increase in intraocular pressure (IOP) after pupil dilation is noted in open-angle glaucoma patients, those with narrow angles and in normal subjects. Asians are more likely to have narrow angles. Moreover, age-related cataract may increase the crowdedness of the angle. This study aimed to assess the effects of mydriatic pupil dilatation on IOP in an elderly Chinese population. Methods: The Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects aged 65 years and older in Shihpai, Taipei, Taiwan. IOP was taken using noncontact tonometry. The pupil was dilated with 1% tropicamide. IOP was measured again after maximal pupil dilatation 1 hour after mydriasis. Results: Of the 2045 participants, 1361 (66.6%) participated in both the questionnaire and eye examinations. The mean IOP before pupil dilatation was 12.9 ± 3.1 mmHg and was 12.8 ± 3.4 mmHg (range: 5-36 mmHg) after pupil dilatation. IOP higher than 21 mmHg after pupil dilation was noted in 17 (1.34%) participants, of whom IOP exceeded 30 mmHg in two (0.16%). Overall, the changes in IOP before and after pupil dilatation were insignificant (p = 0.04). In the final regression analyses, refractive status toward hyperopia (p < 0.01) was the only significant factor associated with an increase in IOP of at least 4 mmHg after pupil dilatation. Conclusion: Our results revealed that the increase in IOP after pharmacological pupil dilatation was minimal, and the incidence of acute angle-closure attack was insignificant. Hyperopic status was the only factor related to an increase in IOP of > 4 mmHg. Caution should be exercised if one is hyperopic or has a history of glaucoma and rechecking IOP in these subjects is suggested after pharmacological mydriasis. [ABSTRACT FROM AUTHOR]

Purpose: To compare 6 methods for intraoperative pupil dilatation in eyes with insufficient pupil size during phacoemulsification.Methods: This was a prospective case-control study. 99 microcoria cataract patients (120 eyes) were collected and were divided into 6 groups(20 eyes each group), and their pupils were dilated by bimanual stretching pupil (group I), pupil radial cut open(group II), mechanical pupil dilatation with iris-retractor hooks (group III), OASIS iris expander (group IV), and Malyguin-ring (Microsurgical company, America) (group V), B-HEX Pupil Expander (Med Invent Devics, India)(group VI),respectively. 3.0 mm clear corneal incision were used in phacoemulsification. All cases were followed up at 1 week and 1, 3, 6 months after the surgery. The best corrected visual acuity (BCVA), intraocular pressure(IOP), corneal endothelium cell density(ECD), pupil diameter(PD) of before and after surgery were compared.Results: One same doctor finished all cataract surgeries successfully. The eyes' condition before surgery and at 6 months after surgery were compared. There were no significant statistical differences for the conditions of the eyes before surgery among six groups. The ECDs were better at 6 months postoperatively in group III and V, median values: 2114/mm2, 1961/mm2. PD was largest in group II (median value: 5.5 mm), which was significantly larger than other groups (Padjusted < 0.05).Conclusions: All 6 methods used in this study were effective for the mechanical dilatation of small pupils and didn't affect the postoperative visual acuity and intraocular pressure in microcoria cataract phacoemulsification. Iris-retractor hooks and the Malyugin Ring can reduce intraoperative corneal endothelium cell loss. Postoperative PD is larger when the iris was cut open radially. [ABSTRACT FROM AUTHOR]

This prospective randomized study aimed to compare the effects of nebulizer drugs on unilateral or bilateral dilation of the pupil that may develop due to mask incompatibility or patient incompatibility in patients receiving inhaled therapy. Following the approval of the local ethics committee, this study was carried out prospectively and observationally in the period from October 1, 2018 to April 1, 2019 in an emergency clinic with an annual capacity of 600,000 patients in a tertiary education and research hospital. The patients were divided into three groups: those given salbutamol alone (200 mcg), those given ipratropium alone (250 mcg/2ml), and those receiving both salbutamol and ipratropium. The pupil diameters of the patients included in the study were measured twice using a pupilometer device at hours 0 and 2 of treatment. Ninety-one patients that received inhaler treatment in the emergency department were included in the study. The process of treatments given to patients with indications was not interrupted. Ipratropium and salbutamol (49.5%) were used together in 45 patients, ipratropium alone in 38 (41.7%), and salbutamol alone in eight (8.8%). When the absolute delta ratios were compared, a statistically significant difference was observed between the patients given salbutamol and those given ipratropium, and between the patients that received salbutamol and those given salbutamol and ipratropium (p=0.001, 95% CI: 1.36-6.11 and p<0.001, 95% CI: 1.51- 6.19, respectively). Salbutamol caused statistically significantly greater pupil diameter changes than the other drugs. Although neurological diagnoses are considered in patients with anisocoria, it should be kept in mind that anisocoria may also be due to the current or the treatment being given. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present methods to calculate pupil size based on various parameters, such as: luminance, age, corneal flux density or monocular/binocular effect. These models allow to distinguish pupil dilation caused by the influence of light and other factors such as psychological state of participants.The developed methods were presented based on empirical data. Various researchers estimate their equations based on oculographic data obtained in the course of experiments. The presented plots are based on those equations. Different approaches can be compared to show the difference between particular models.The methods presented in this paper enable a more detailed investigation of the influence of various parameters on the pupil. It can be used to better estimate the influence of light on pupil size. The main changes occurring in pupil size, i.e. contractions and dilation, are caused by light. Other criteria such emotional arousal, cognitive processes or even memory operations can also alter the pupil, among which the decoupling of light is important. The presented approach is distinct from other similar studies because it decouples the pupillary light reflex.

We tested the hypothesis that a still-face person keeping direct gaze can express an emotion. The prospective study involved healthy volunteers as senders (n = 100). Four pictures of the face of a participant who tried to express certain emotion by gaze were obtained (Neutral – Angry – Sad – Happy). Twenty blinded judges judged the ability to express the emotions. We used the pupil/canthal tilt index for analysis of pupil dilatation. The pictures with emotions (n = 300) presented perfectly expressed emotions – 207 (69%), flawed expressions – 38 (12.66%), and lack of expression or inability to express an emotion – 55 (18.33%). The pupil/tilt index was: neutral gaze – 0.18, angry gaze – 0.21, sad gaze – 0.2, and happy gaze – 0.19. Majority of senders express an emotion by gaze very good. The facial expression of an emotion can be adequately achieved with only minimal muscular involvement when the gaze is the main component of such expression. An "emotional gaze" during a still-face or static face situation may be a result of the combined slight activity of small intraorbital muscles and broader involvement of sympathetic and parasympathetic reactions. [ABSTRACT FROM AUTHOR]

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ObjectiveThe aim of the present study was to investigate the pupillary response to word identification in cochlear implant (CI) patients. Authors hypothesized that when task difficulty (i.e., addition of background noise) increased, pupil dilation markers such as the peak dilation or the latency of the peak dilation would increase in CI users, as already observed in normal-hearing and hearing-impaired subjects.MethodsPupillometric measures in 10 CI patients were combined to standard speech recognition scores used to evaluate CI outcomes, namely, speech audiometry in quiet and in noise at +10 dB signal-to-noise ratio (SNR). The main outcome measures of pupillometry were mean pupil dilation, maximal pupil dilation, dilation latency, and mean dilation during return to baseline or retention interval. Subjective hearing quality was evaluated by means of one self-reported fatigue questionnaire, and the Speech, Spatial, and Qualities (SSQ) of Hearing scale.ResultsAll pupil dilation data were transformed to percent change in event-related pupil dilation (ERPD, %). Analyses show that the peak amplitudes for both mean pupil dilation and maximal pupil dilation were higher during the speech-in-noise test. Mean peak dilation was measured at 3.47 ± 2.29% noise vs. 2.19 ± 2.46 in quiet and maximal peak value was detected at 9.17 ± 3.25% in noise vs. 8.72 ± 2.93% in quiet. Concerning the questionnaires, the mean pupil dilation during the retention interval was significantly correlated with the spatial subscale score of the SSQ Hearing scale [r(8) = −0.84, p = 0.0023], and with the global score [r(8) = −0.78, p = 0.0018].ConclusionThe analysis of pupillometric traces, obtained during speech audiometry in quiet and in noise in CI users, provided interesting information about the different processes engaged in this task. Pupillometric measures could be indicative of listening difficulty, phoneme intelligibility, and were correlated with general hearing experience as evaluated by the SSQ of Hearing scale. These preliminary results show that pupillometry constitutes a promising tool to improve objective quantification of CI performance in clinical settings.

Objective: The aim of the present study was to investigate the pupillary response to word identification in cochlear implant (CI) patients. Authors hypothesized that when task difficulty (i.e., addition of background noise) increased, pupil dilation markers such as the peak dilation or the latency of the peak dilation would increase in CI users, as already observed in normal-hearing and hearing-impaired subjects. Methods: Pupillometric measures in 10 CI patients were combined to standard speech recognition scores used to evaluate CI outcomes, namely, speech audiometry in quiet and in noise at +10 dB signal-to-noise ratio (SNR). The main outcome measures of pupillometry were mean pupil dilation, maximal pupil dilation, dilation latency, and mean dilation during return to baseline or retention interval. Subjective hearing quality was evaluated by means of one self-reported fatigue questionnaire, and the Speech, Spatial, and Qualities (SSQ) of Hearing scale. Results: All pupil dilation data were transformed to percent change in event-related pupil dilation (ERPD, %). Analyses show that the peak amplitudes for both mean pupil dilation and maximal pupil dilation were higher during the speech-in-noise test. Mean peak dilation was measured at 3.47 ± 2.29% noise vs. 2.19 ± 2.46 in quiet and maximal peak value was detected at 9.17 ± 3.25% in noise vs. 8.72 ± 2.93% in quiet. Concerning the questionnaires, the mean pupil dilation during the retention interval was significantly correlated with the spatial subscale score of the SSQ Hearing scale [ r (8) = −0.84, p = 0.0023], and with the global score [ r (8) = −0.78, p = 0.0018]. Conclusion: The analysis of pupillometric traces, obtained during speech audiometry in quiet and in noise in CI users, provided interesting information about the different processes engaged in this task. Pupillometric measures could be indicative of listening difficulty, phoneme intelligibility, and were correlated with general hearing experience as evaluated by the SSQ of Hearing scale. These preliminary results show that pupillometry constitutes a promising tool to improve objective quantification of CI performance in clinical settings. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to evaluate whether intraocular (IOP) elevation post-cataract surgery can be reduced by using tropicamide and phenylephrine only, without cyclopentolate. Medical records across two surgical facilities were analyzed. One surgical facility (Cohort A) used a combination of tropicamide, cyclopentolate, and phenylephrine preoperatively, while the other (Cohort B) used tropicamide and phenylephrine only. Of patients in Cohort A, 63.6% (n = 7) had a higher IOP in the operated eye, while it was only 27.3% (n = 3) in Cohort B. Therefore, it is preferable to exclude the use of cyclopentolate in the preoperative dilation regimen of patients undergoing cataract surgery. However, a study with a larger sample population is required to further evaluate the significance of these results. [ABSTRACT FROM AUTHOR]

Introduction: Dilated pupil is an important factor for good visualization during pars plana vitrectomy (PPV) in patients with diabetic retinopathy. Despite its side effects, intravitreal adrenaline has been used to maintain pupil dilation. Objective: To assess the effect of intravitreal adrenaline infusion on pupil dilation in patients with diabetic retinopathy undergoing PPV. Methods: This study included 30 eyes of 30 patients with progressive diabetic retinopathy underwent PPV. Pupils of all eyes were dilated by topical application of a combination of 1% tropicamide and 2.5% phenylephrine, and eyes were randomized 1:1 to continuous intravitreous infusion of adrenaline (0.5 mg/500 ml in balanced salt solution) or vehicle control. Surgical procedures were recorded with a high definition video recorder. Normalized pupillary area (NPA) was measured on recorded images before and at the end of surgery. Results: Post-operative NPA differed significantly between the two groups (p = 0.04). By contrast, pre-operative NPA (p = 0.81) and changes in NPA (p = 0.17) did not. Conclusion: Intravitreal infusion of adrenaline did not have a significant effect on pupil dilation, compared with non-adrenaline, in patients with diabetic retinopathy undergoing PPV.

Objective: Cerebellopontine angle (CPA) cistern widening occurs as a result of herniating temporal lobe as it pushes the midbrain and thus the pons away from the petrous temporal bone throughout its descent. This is clinically observed as pupillary asymmetry (reactive or non-reactive) and as the herniation progresses, deterioration of neurological status follows. The aim of this study is to assess the radiological feature of ipsilateral CPA cisternal widening in patients with traumatic brain injury, as a prognostic indicator for timely cisternal drainage and bone flap replacement. Methods: In this retrospective study, 31 patients undergoing cisternal drainage for traumatic brain injury were included. The presenting demographic, clinical and radiological signs were recorded and results were analyzed to assess the significance of intervention when CPA cisterns were widened, and its correlation with clinical presentation and prognosis. Results: The overall mean age was 35.68 ± 8.95 years, with 61.3% males and 38.7% females. All patients presented with anisocoria and out them, 26 had unilateral obliterates suprasellar cisterns and widened CPA cisterns; with 2 of them showing unilateral pupil non-reactivity as well. The other 5 patients presented with bilaterally dilated fixed pupils and the corresponding scans showed complete obliteration of CPA cistern. These findings were statistically significant (p-value<0.05, Cramer’s v=0.812). There was a significant association between CP angle cistern morphology and corresponding motor scores (p-value<0.005; Cramer’s V: 0.759). The outcome in patients after 6 weeks follow up was significantly correlated to the CP angle cisternal widening and obliteration (p-value: 0.001; Cramer’s V: 0.718) and the consequent changes in motor scores (p-value<0.05; Cramer’s V: 0.880). Conclusion: CP Angle cisternal widening is a clear indication of impending uncal herniation, identified clinically by pupil asymmetry. Timely surgical intervention using a cisternal drainage can prevent progression to involvement of more posterior structures, which otherwise result in a decreased motor score and a poor prognosis. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy in pupil dilatation between a mixture containing 0.75% tropicamide and 2.5% phenylephrine and the alternate application of 1% tropicamide and 10% phenylephrine eye drops. Material and Methods : Patients requiring pupil dilatation were randomized to receive one drop of the mixture every 10 min for four times or our standard application of one drop of 1% tropicamide alternating with one drop of 10% phenylephrine every 10 min for two cycles. Pupil size was measured under bright light with the pupil gauge before, and every 5 min after initial application for 40 min. Application of the drops was discontinued once the pupil diameter reached 7 mm. Blood pressure and pulse rate were monitored every 15 min. Results: Of 40 patients (age 57.3±10.9 years, range 35-70 years), 22 were randomized into the mixture group and 18 into the alternate drug group. Baseline pupil sizes were 1.7±0.5 mm in the mixture group and 1.8±0.4 mm in the alternate drug group. The pupils were successfully dilated to 7 mm within 40 min in 17 patients of the mixture group compared to seven patients in the alternate drug group ( P =0.004, Log Rank test). The mean pupil sizes at 40 min were 6.6±0.8 and 6.0±0.9 mm in the mixture and alternate drug groups respectively ( P =0.050, t-test). Blood pressure and pulse rate were stable and similar in both groups. Conclusions: The mixture of 0.75% tropicamide and 2.5% phenylephrine is superior to our standard application of 1% tropicamide alternating with 10% phenylephrine. It provides faster and more successful pupil dilatation within 40 min.

Objective: To compare the mean increase in pupil diameter by intracameral injection of 1% lidocaine versus topical mydriatics during phacoemulsification cataract extraction. Materials & Methods: This study was conducted in the Department of Ophthalmology Services Hospital Lahore, from 1st June 2014 to 30th Nov 2014.100 patients suffering from age-related cataract with age range from 50 to 72 years were selected, in which two groups were made on the basis of intracameral lidocaine 1% and topical mydriatics. In Group A, there were 48.0 % (n=24) male and 52.0 % (n=26) female patients while Group B had 44.0 % (n=22) male and 56.0 % (n=28) female patients. Informed consent was obtained from each patient. 100 patients were divided topical and intracameral group. Baseline pupillary diameter was measured 1 hour before surgery in topical group and just before surgery in the intracameral group (D1). After that, patients in Group A were given 3 drops of cyclopentolate 1% at 10 minute intervals before surgery for total of 3 doses. Patients in Group B received intracameral 0.3 ml of non preserved lidocaine 1% injected into the anterior chamber at the beginning of surgery. The pupillary diameter was repeated with the same caliper just before surgery in the topical group and 90 seconds after intracameral injection in the intracameral group. (D2). Increased in pupillary diameter was measured by subtracting initial diameter (D1) from final diameter (D2) by same person unaware of study group. Results: Both groups were comparable to each other in terms of age and gender distribution. Mean increase in pupillary diameter was 3.70 ± 0.69 mm in mydriatic group and 2.40 ± 0.97 mm in intracameral group. (P Value 0.001). Conclusion: There is greater increase in mean pupil diameter by topical mydriatics than intracameral injection of 1% lidocaine during phacoemulsification cataract extraction. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine the change in intraocular pressure for four consecutive hours after pupil dilation of the patients with pseudoexfoliation syndrome (PES) and without pseudoexfoliation. Materials and Methods: We examined 60 eyes of 60 patients, 30 of them with PES and 30 without pseudoexfoliation. IOP was measured with Goldmann Aplanation Tonometry before dilation and hourly for four consecutive hours after dilation with tropicamide 1% and phenylephrine 2.5% eyedrops in all patients. Pigment dispersion into the anterior chamber was classified by the same examiner. Results: Gender, age, central cornea thickness and IOP before dilatation measurements of the groups were similar. IOP measurements after dilatation were statistically significant, both in the PES group and the control group (p<0.000, p=0.002; respectively). When two groups were compared in terms of IOP change; IOP 1., 2., and 3 hours after dilatation were statistically significant. A significant correlation was found in the PES group's IOP change and first hour anterior chamber pigment intensity, and patients with pigment dispersion in the PES group all had significant IOP rise. While the PES group had a peak IOP in the 2. Hour; IOP of the control group increased progressively in 4 hours. Conclusion: The effect on pupil dilatation in IOP must be noticed and it should be considered that pigment intensity of the anterior chamber during the first hour of dilatation can be an indicator of IOP rise in patients with PES. [ABSTRACT FROM AUTHOR]

Context: Calcium channel inhibitors are being investigated as potential therapeutic adjuncts to reduce painful ciliary muscle spasm and control intraocular pressure in glaucoma. Relatively little is known about the effect of topical administration of calcium channel blockers in humans. Objective: (1) To describe prolonged fixed pupil dilation resulting from exposure to topical amlodipine (2) to review the evidence that links calcium channel blockers with mydriasis and (3) to discuss the implications for glaucoma pharmacotherapy. Design: Single interventional case report, literature review (including human and animal studies) and analysis of reported adverse drug reactions (ADRs) records in the USA and UK. Case: A 35-year-old female doctor presented to eye casualty with blurred vision and bilateral, fixed, dilated pupils. A history of exposure to liquid amlodipine while preparing a paediatric chemotherapy regimen for a neuroblastoma patient was elicited. The patient was reassured and observed. Results: Pupil function returned to normal within 48 h. A multi-national review of adverse drug reactions reports was conducted, as well as an extensive literature search for case reports and experimental studies. To the authors' knowledge this is the first report of amlodipine causing mydriasis and we discuss the potential molecular mechanism. Conclusions: This case is the first to suggest that calcium channel blockers can cause prolonged mydriasis. These agents have been investigated as potential adjuncts in glaucoma therapy. As accidental topical exposure to amlodipine can cause prolonged pupil dilation, it could precipitate angle closure in predisposed patients. [ABSTRACT FROM AUTHOR]

. Purpose: To evaluate the long-term safety of intracameral mydriatics (ICM) in phacoemulsification cataract surgery compared with conventional topical mydriatics (TM). Methods: A total of 45 patients were examined 6 years after phacoemulsification cataract surgery. The patients had previously participated in a prospective randomized double-blind study including 60 patients, operated with either ICM or TM. The follow-up included best-corrected visual acuity (BCVA), intraocular pressure (IOP), grade of posterior capsule opacification (PCO), YAG laser capsulotomy rate, pupil size, corneal thickness and endothelial morphology. Results: No differences in postoperative BCVA, IOP, pupil size, PCO or YAG rate were observed between the groups. Endothelial cell loss, endothelial morphology and corneal thickness were also equivalent. Conclusions: Intracameral mydriatics is a safe alternative to topical mydriatics in phacoemulsification cataract surgery with no long-term disadvantages at 6-year follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Pupil dilatation (PD) was produced by vaginocervical mechanical stimulation (VCMS) in intact rats, and in rats with spinal cord (SC) transection at level T7 (i.e., above the level of entry into SC of all genitospinal nerves). After transection of SC, bilateral vagotomy abolished PD in response to VCMS, providing evidence that the vagus nerve conveys VCMS directly from the genitalia to the brain. In the present study, unilateral electrical stimulation of the central stump of the vagus nerve (ESV) transected at the spinal cervical level produced PD in otherwise intact rats, and in rats that had undergone bilateral cervical sympathectomy (CSX). Unilateral ESV produced bilaterally symmetrical PD. By contrast, unilateral electrical stimulation of the cervical sympathetic chain produced PD only ipsilateral to stimulation. These results provide evidence that activation of sympathetic outflow, although sufficient to produce PD, does not, by itself, mediate PD in response to ESV. After bilateral CSX, transection of the brain stem at the mid-pontine level abolished PD in response to unilateral ESV, while preserving the pupillary light reflex. Since CSX eliminates all sympathetic control of the pupil, and transection of the brain stem at the mid-pontine level blocks access of vagus-induced activity that ascends to the oculomotor nucleus in the midbrain, we conclude that ESV produces PD, at least in part, via inhibition of output from the (parasympathetic) oculomotor nucleus. [Copyright &y& Elsevier]

Background: The ability to perform biometry accurately on a dilated pupil can greatly facilitate the efficiency of a cataract service as it can be done on the day of surgery. The purpose of this study was to assess the repeatability of axial length (AL) calculations in undilated pupils and measure the difference in predicted and actual refractive outcomes in dilated pupils compared with undilated pupils. Methods: First, intraobserver repeatability was assessed by taking two consecutive recordings of AL using applanation A-scan ultrasonography in undilated pupils in 21 eyes. The mean AL for each eye was compared with a measurement made following pupil dilatation. Second, we audited the mean spherical equivalent refractive errors following routine cataract surgery in 38 patients with undilated pupils and 36 patients with dilated pupils. Results: The mean difference in intraobserver measurements was −0.05 mm (standard deviation [SD] 0.15) with pupils undilated. Following pupil dilatation, the mean dilated AL differed from the mean undilated AL reading by only 0.03 mm ( P > 0.05). The mean differences between planned and actual refractive error were 0.71D (SD 0.54) and 0.55D (SD 0.41) in dilated and undilated patients, respectively. This was not statistically significant ( P > 0.05). The range of differences between target and actual refraction was −1.45D to 2.70D for undilated patients and −1.88D to 1.18D in dilated patients. Conclusion: Although there was a greater spread of postoperative refractive errors in the dilated group, there were no statistically or clinically significant differences in postoperative refractive errors between the two categories of patients. Our study shows that applanation biometry may be safely performed for the purpose of cataract surgery after pupil dilatation. [ABSTRACT FROM AUTHOR]

The hyoscine patch is effective and is frequently used in motion sickness treatment. Not uncommonly, it is used to control excessive respiratory secretions in palliative patients. Patients, healthcare workers, and caregivers who administer these may experience a benign, although worrying, mydriasis should they inadvertently rub their eye after handling the patch. A 46-year-old staff nurse working in a stroke ward presented with sudden-onset unilateral enlarged pupil. To rule out any intracranial pathology, the stroke team requested an urgent head computed tomography (CT) scan, which showed no abnormality. Upon ophthalmology review, nonreactive dilated left pupil was noted. Examination was otherwise unremarkable with no focal neurology findings. Following further history, she recalled applying a hyoscine patch to a patient in the morning. Two days later, her left pupil returned to normal size. This unique presentation of pharmacological mydriasis reinforces the importance of a detailed targeted history to avoid unnecessary investigations and anxiety, as well as the importance of informing patients, healthcare workers, and caregivers of this peculiar side-effect. [ABSTRACT FROM PUBLISHER]