Shah P, Jacks A S, Adams G G
Moorfields Eye Hospital, London, UK.
Eye (Lond). 1997;11 ( Pt 6):845-6. doi: 10.1038/eye.1997.216.
Cycloplegia is a traumatic experience for most children, as guttae cyclopentolate stings on instillation into the conjunctival sac. This may result in inadequate cycloplegia, difficulty in further examination and a child who is scared of both the doctor and the ophthalmology department. Guttae proxymetacaine hydrochloride 0.5% (Ophthaine, Proparacaine) is a topical local anaesthetic that does not sting on instillation.
Eighty-eight consecutive children in the paediatric clinic were assessed. The response of the patient to previous use of cyclopentolate alone was assessed by the parents of the child using a grading scheme. The use of proxymetacaine prior to instillation of cyclopentolate was then assessed using the same grading system.
Seventy per cent of the children who received cyclopentolate alone were assessed to have cried and been unhappy. Ninety-one per cent of the children who received cyclopentolate after proxymetacaine were assessed to have shown no adverse reaction to the cycloplegia and remained happy.
This study shows that use of proxymetacaine prior to cyclopentolate results in atraumatic cycloplegia in children. This can confer multiple benefits on the doctor-patient relationship.
对于大多数儿童来说，睫状肌麻痹是一次痛苦的经历，因为将环喷托酯滴眼液滴入结膜囊时会有刺痛感。这可能导致睫状肌麻痹不充分、进一步检查困难，还会让孩子害怕医生和眼科科室。0.5%的盐酸丙美卡因滴眼液（奥夫卡因、丙美卡因）是一种局部麻醉剂，滴入时不会引起刺痛。
对儿科门诊连续88名儿童进行评估。儿童家长使用分级方案评估患儿之前单独使用环喷托酯时的反应。然后使用相同的分级系统评估在滴入环喷托酯之前使用丙美卡因的情况。
单独使用环喷托酯的儿童中，70%被评估为哭闹且不开心。在使用丙美卡因后再使用环喷托酯的儿童中，91%被评估为对睫状肌麻痹无不良反应且保持开心。
本研究表明，在使用环喷托酯之前使用丙美卡因可使儿童实现无创伤性睫状肌麻痹。这可为医患关系带来诸多益处。
