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Why Dilation Reversal Drops Are Not Currently an Option


Getting your eyes dilated can be inconvenient – dilation makes your eyes light sensitive, which can make it difficult to read books or use phones and computers for a few 4 hours.

So wouldn’t it be great to have another drop to reverse the effects of dilation?

On Dec. 31, 1990, dapiprazole, under the trade name Rev-Eyes, was approved by the FDA and thought to be the answer to all the post-dilation problems. It was marketed for treatment of medically-induced dilation by stimulating pupillary constriction and restoration of accommodative function for reading.

In clinical practice, dapiprazole took between one to two hours to return pupils to pre-dilation size.

Side effects such as stinging upon instillation, conjunctival hyperemia (redness of eye), headache, and a few instances of ptosis (lid drooping), with a possible additional dollar cost to patients, seemed to lessen dapiprazole’s overall clinical benefit.

Reading ability returned in approximately 43 minutes with dapiprazole vs 66 minutes without the drop (Optom Vis Sci 1994 May; 71(5):319-22). The main complaint that people had after using dapiprazole was the conjunctival hyperemia, which lasted more than three hours. The other issue was that dapiprazole was costly, so some practitioners included an additional charge for the reversal of dilation to offset the cost.

The full adverse reaction profile according to Drugs.com is as follows:

"Adverse Reactions: In controlled studies, the most frequent reaction to dapiprazole was conjunctival injection lasting 20 minutes in over 80% of patients. Burning on instillation of dapiprazole hydrochloride ophthalmic solution was reported in approximately half of all patients. Reactions occurring in 10% to 40% of patients included ptosis, lid erythema, lid edema, chemosis, itching, punctate keratitis, corneal edema, browache, photophobia and headaches. Other reactions reported less frequently included dryness of eyes, tearing and blurring of vision."

Currently, Rev-Eyes is off the market. The FDA has stated that Rev-Eyes was not withdrawn from the market for reasons of safety or effectiveness.

At this time, there is nothing available for reversal of dilation. People who get dilated will still need to wear their sunglasses and to put off reading for a couple of hours until the effects of the dilation drops wear off.

 

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

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Ask Dr. Stewart Your Eye Care Questions

What can be expected during a contact lens fitting?

A patient can expect to have a different experience when having a contact lens fitting. In addition to the eyeglass exam, questions will be asked to determine which contact lens will work best for them. Will they want to leave the lenses in their eyes overnight or will they remove them every day? Will they wear them only occasionally or will they be for everyday use? Do they want a contact lens that they throw away every day or do they want a contact lens that they have to clean and disinfect? If the patient is over age 40 and has a compromised ability to see up close, how will they see up close with their contact lenses? Will they wear readers over their distant contacts, or will they wear multifocal contacts, or will they wear monovision?

Are some people more prone to having Dry Eyes than others?

Experiencing dry eye symptoms is more common as we grow older, particularly in people 50 years of age and older. Hormonal changes in women who are experiencing menopause or who are post-menopausal. Inflammation in our body can affect the tear gland's ability to produce tears. Eye or health conditions such as glaucoma, diabetes, lupus, rheumatoid arthritis, and Sjogren's Syndrome can be associated with Dry Eyes. Environmental conditions such as dry winter air, dry indoor heated air, working on the computer, and wearing contact lenses can cause Dry Eyes.

Are there advantages to single-use contact lenses? What are they?

Single-use daily wear contacts are convenient to the patient and a healthy recommendation from their eye doctor. At the end of the day, the patient only has to dispose of the contacts. There is no need to take the contacts out to clean and disinfect them. The patients time and money spent on solutions and caring for them are eliminated. Not to mention that the next time they wear a contact, they will be wearing a brand new contact! The single best recommendation your eye doctor can make is to recommend single-use daily wear contacts. They are the healthiest contact that can be worn. The contact lens pathology issues of wearing the same contact for two or four weeks such as neovascularization, microcystic edema, and bacterial infections are greatly reduced.

What is an eye infection?

Your eyes can get infections from bacteria, fungi, or viruses. Eye infections can occur in different parts of the eye and can affect just one eye or both. Two common eye infections are conjunctivitis (also known as pink eye) and lid styes which are swollen lid bumps that can also be painful. Common signs of an eye infection are pain, itching, or a sensation of a foreign body in the eye, photosensitivity, redness or small red lines in the white of the eye, discharge of yellow pus that may be crusty upon awaking, and tears.

What happens during a typical Diabetic Eye Exam?

Your Eye Doctor will evaluate the back of your eye called the Retina to check for leaking blood vessels. Diabetic retinopathy occurs when elevated blood sugars damage the walls of the blood vessels. The vessel walls may thicken, leak, develop clots, close off, or grow balloon-like defects called microaneurysms.

My eyes tear all the time. Why do you call it Dry Eyes?

Your eyes have extra tears because your eyes produce extra tears to combat irritation and dryness. A better way to describe Dry Eyes is tear film instability, which refers to the composition of your tears not being in the proper composition. Stopping eyes from producing extra tears is a goal in the treatment of Dry Eyes.

At what age should my child have his/her eyes examined?

If you ask 10 different Doctors you will get 10 different answers. Newborns have their eyes checked in the birthing ward for starters. From birth to age 5 their eyes are growing. At age 5 is a good time to schedule a regular eye examination, however, if any unusual eye behavior is observed under age 5 an eye exam should be scheduled at that time. Unusual eye behavior such as eye squinting, a head tilt, or having to get close to see.