Fundoscopy: to dilate or not to dilate?

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7532.3 (Published 5 January 2006)
Cite this as: BMJ 2006;332:3

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  1. Gerald Liew, research fellow (gerald_liew@yahoo.com.au),
  2. Paul Mitchell, professor of ophthalmology,
  3. Jie Jin Wang, senior research fellow,
  4. Tien Yin Wong, associate professor of ophthalmology
  1. Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), Westmead Millennium Institute, University of Sydney, Australia and Vision Co-operative Research Centre
  2. Centre for Vision Research, Department of Ophthalmology (Westmead Hospital), Westmead Millennium Institute, University of Sydney, Australia and Vision Co-operative Research Centre
  3. Centre for Eye Research Australia, University of Melbourne, Victoria, Australia

    The risk of precipitating glaucoma with mydriatic eye drops is very small

    Fundoscopy is commonly used by non-ophthalmologists to screen for diabetic retinopathy.1 The sensitivity of fundoscopy through a dilated pupil for detecting diabetic retinopathy is twice as high as detection through an undilated pupil,2 but surveys of general practitioners have found that only 1 in 250 regularly dilate pupils, even when assessing patients at high risk of diabetic eye disease.3 A common reason for not dilating pupils is concern about the risk of precipitating acute angle closure glaucoma.3 How big is this risk?

    Recent population based studies indicate that this risk is extremely low. In the Rotterdam study of 6760 people, routine use of mydriatic eye drops in all participants aged 55 and over precipitated acute angle closure glaucoma in only two individuals (0.03%).4 The Baltimore eye survey of 4870 people found no cases of acute glaucoma precipitated by mydriasis.5 In Australia …

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