Steinmann W C, Millstein M E, Sinclair S H
Ann Intern Med. 1987 Aug;107(2):181-4. doi: 10.7326/0003-4819-107-2-181.
Primary care practitioners omit pupillary dilation from funduscopic examination, possibly because of time constraints, poor patient compliance, or fear of adverse reactions. Nevertheless, the omission of this procedure may lead to the inadequate visualization of the fundus for screening. We administered a topical solution of 1% tropicamide to 30 adults to determine the course of pupillary dilation over time and whether adequate dilation could be attained within a routine clinic visit. Pupil diameters were measured every 5 minutes in a 30-minute period. The initial mean pupillary diameter was 2.4 mm and the endpoint was 5.5. Dilation was significantly slower in those older than 50 years of age. However, at 15 minutes 87% of the patients, regardless of age, had achieved dilation to at least 4 mm, which should be sufficient for screening under most circumstances. We conclude that adequate pupillary dilation in adults usually can be achieved within the time frame of a routine office visit and thus should not be a deterrent to routine funduscopic screening by primary care practitioners.
基层医疗从业者在眼底检查时不进行瞳孔散大，可能是由于时间限制、患者依从性差或担心不良反应。然而，不进行此操作可能会导致眼底筛查时观察不充分。我们给30名成年人使用了1%托吡卡胺的局部溶液，以确定瞳孔随时间散大的过程，以及在常规门诊就诊期间是否能达到充分散大。在30分钟内每5分钟测量一次瞳孔直径。初始平均瞳孔直径为2.4毫米，终点为5.5毫米。50岁以上的人散大明显较慢。然而，15分钟时，87%的患者，无论年龄大小，瞳孔已散大至至少4毫米，在大多数情况下这应该足以进行筛查。我们得出结论，成年人通常可在常规门诊就诊时间内实现充分的瞳孔散大，因此不应成为基层医疗从业者进行常规眼底筛查的阻碍。
