EEG changes as an indication of central nervous system involvement following cyclopentolate 1% eye drops; a randomized placebo-controlled pilot study in a pediatric population

• Published in: Strabismus Vol. ahead-of-print; no. ahead-of-print; pp. 1 - 15
• Main Authors: van Minderhout, Helena Maria, Joosse, Maurits Victor, Klaassen, Erica Surya, Schalij-Delfos, Nicoline Elisabeth
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.06.2023
• Subjects: Adolescent; Adverse reactions; anticholinergic syndrome; Central Nervous System; Child; Child, Preschool; Cyclopentolate; cycloplegics; Electroencephalography; Female; Humans; Male; Mydriatics; objective refraction; Ophthalmic Solutions; Pilot Projects; Prospective Studies; retinoscopy; side effects; Single-Blind Method; Adverse reactions; cycloplegics; cyclopentolate; retinoscopy; side effects; anticholinergic syndrome; objective refraction; central nervous system
• DOI: 10.1080/09273972.2023.2218455
• ISSN: 0927-3972; 1744-5132

To compare EEG-patterns after instillation of cyclopentolate versus placebo eye drops. Prospective, randomized, placebo-controlled, and observational pilot study is presented. Ophthalmology outpatient clinic Dutch metropolitan hospital. Healthy 6- to 15-year-old volunteers with normal or low BMI requiring a cycloplegic refraction/retinoscopy. Randomized; 1 visit 2 drops cyclopentolate-1% and 1 visit 2 drops placebo (saline-0.9%). Single-blind: conducting researcher. Double blind: subjects, parents, clinical-neurophysiology staff, neurologist, and statistician. A 10-min baseline EEG-recording, drop-application, and follow-up to at least 45 min. Primary outcome: Detection of CNS changes, i.e. EEG-pattern changes, following two drops of cyclopentolate-1%. Secondary outcome: Determination of the extent of these pattern changes. Thirty-six cyclopentolate-1% saline-0.9% EEG registrations were made in 33 subjects;  18 males and 15 females. Three subjects were tested twice (interval 7 months). Nine out of fourteen (64%) of the 11- to 15-year-old children reported impaired memory, attention, alertness, as well as mind wandering following cyclopentolate. Drowsiness and sleep were seen in EEG-recordings of 11 subjects (33%) following cyclopentolate. We observed no drowsiness nor sleep during placebo recordings. The mean time to drowsiness was 23 min. Nine subjects arrived in stage-3 sleep but none arrived in REM-sleep. In subjects without sleep (N=24), significant changes compared to placebo-EEG were present for many leads and parameters. The main findings during awake eye-open recording were as follows: 1) a significant increase of temporal Beta-1,2 and 3-power, and 2) a significant decrease in: a) the parietal and occipital Alpha-2-power, b) the frontal Delta-1-power, c) the frontal total power, and d) the occipital and parietal activation synchrony index. The former finding reflects cyclopentolate uptake in the CNS, and the latter findings provide evidence for CNS suppression. Cyclopentolate-1% eye drops can affect the CNS and may cause altered consciousness, drowsiness, and sleep with concomitant EEG results in both young children and children in puberty. There is evidence that cyclopentolate has the potency to act as a short acting CNS depressant. Nevertheless, however, cyclopentolate-1% can safely be used in children and young adolescents.