Cycloplegia is crucial for reliable pediatric ophthalmology examinations. This document provides a re commendation for pediatric cycloplegia and mydriasis for Brazilian ophthalmologists. This article was developed based on literature reviews; the clinical experience of Brazilian specialists, as obtained through questionnaires; and the consensus of the Expert Committee of the Brazilian Pediatric Ophthalmology Society. According to the best evidence and formulations available in Brazil, this committee recommends the use of one drop of 1% cyclopentolate plus one drop of 1% tropicamide in children older than 6 months and two drops of 1% tropicamide 05 minutes apart for those younger than 6 months. Mydriasis may be increased by a single drop of 2.5% phenylephrine. For retinopathy of prematurity screening, the recommendation is 0.5% or 1% tropicamide, administered two or three times, 5 minutes apart, and 2.5% phenylephrine, used preferably once. In all scenarios, we recommend the use of a prior drop of 0.5% proxymetacaine.
Introduction Anterior segment duplicity with two lenses is a rare event which pathogenesis is still unknown. Different ocular and systemic abnormalities might be associated with such event. Case observations Hereby we describe a case of a 6-months female child referred to our service due to signs of ocular malformation in the left eye. The ocular exam showed a double anterior segment with twin lenses in one single eye, associated with double lamellar opacity and persistence of the two hyaloid arteries. The patient underwent surgical treatment with lensectomy and vitrectomy aiming visual stimulation and prevention of definitive visual loss secondary to amblyopia. Conclusion In any case of ocular malformation, efforts to provide adequate visual stimulus are necessary to avoid amblyopia. In our case, the opacified lenses were removed, the patient adapted contact lenses and will be followed-up for visual stimulation at the ophthalmic pediatric division aiming the best visual prognosis possible.
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