Causual Effects of Mydriatic Eye Drops

I would like to point out the risk of a drug-induced acute angle closure due to mydriatic eye drops.

The risk of 0.03% given in the article for unselected people over 55 years of age sounds harmless, but the risk increases significantly with a reduced anterior chamber depth (1). About 3% of the population is at high risk due to a flattened anterior chamber. From the age of 50, this risk increases approximately linearly with age (2). In severely hyperopic older patients, the risk of acute angle closure should not be underestimated. It is likely that every ophthalmologist has inadvertently triggered acute angle closure after diagnostic mydriasis during his/her career. The result for the practice: dilated pupils are harmless in children and young patients, even if they are highly hyperopic (3). In hyperopic patients over 50 years of age, the depth of the anterior chamber should be assessed prior to diagnostic mydriasis, which is not always possible in practices. In general, caution is advised for patients with hyperopia over + 3 diopters spherical equivalent and over 50 years old. However, emmetropic patients can also have a very shallow anterior chamber. In our ophthalmology practice, such high-risk patients receive one dose of prophylactic pilocarpine 2% eye drops after diagnostic mydriasis.