Prolonged exposure to air or strong light may cause oxidation and discoloration.
Do not use if solution is brown or contains a precipitate.
Vasoconstriction and Pupil Dilatation
NEO-SYNEPHRINE hydrochloride 10 percent ophthalmic solutions are especially
useful when rapid and powerful dilatation of the pupil and reduction of congestion
in the capillary bed are desired. A drop of a suitable topical anesthetic may
be applied, followed in a few minutes by 1 drop of the NEO-SYNEPHRINE hydrochloride
10 percent ophthalmic solutions on the upper limbus. The anesthetic prevents
stinging and consequent dilution of the solution by lacrimation. It may occasionally
be necessary to repeat the instillation after one hour, again preceded by the
use of the topical anesthetic.
Uveitis: Posterior Synechiae
NEO-SYNEPHRINE hydrochloride 10 percent ophthalmic solutions may be used in
patients with uveitis when synechiae are present or may develop. The formation
of synechiae may be prevented by the use of the 10 percent ophthalmic solutions
and atropine to produce wide dilatation of the pupil. It should be emphasized,
however, that the vasoconstrictor effect of NEO-SYNEPHRINE hydrochloride may
be antagonistic to the increase of local blood flow in uveal infection.
To free recently formed posterior synechiae, 1 drop of the 10 percent ophthalmic
solutions may be applied to the upper surface of the cornea. On the following
day, treatment may be continued if necessary. In the interim, hot compresses
should be applied for five or ten minutes three times a day, with 1 drop of
a 1 or 2 percent solution of atropine sulfate before and after each series of
compresses.
Glaucoma
In certain patients with glaucoma, temporary reduction of intraocular tension
may be attained by producing vasoconstriction of the intraocular vessels; this
may be accomplished by placing 1 drop of the 10 percent ophthalmic solutions
on the upper surface of the cornea. This treatment may be repeated as often
as necessary.
NEO-SYNEPHRINE hydrochloride may be used with miotics in patients with wide
angle glaucoma. It reduces the difficulties experienced by the patient because
of the small field produced by miosis, and still it permits and often supports
the effect of the miotic in lowering the intraocular pressure. Hence, there
may be marked improvement in visual acuity after using NEO-SYNEPHRINE hydrochloride
in conjunction with miotic drugs.
Surgery
When a short-acting mydriatic is needed for wide dilatation of the pupil before
intraocular surgery, the 10 percent ophthalmic solutions or 2.5 percent ophthalmic
solution may be applied topically from 30 to 60 minutes before the operation.
Refraction
Prior to determination of refractive errors, NEO-SYNEPHRINE hydrochloride 2.5
percent ophthalmic solution may be used effectively with homatropine hydrobromide,
atropine sulfate, or a combination of homatropine and cocaine hydrochloride.
For adults, a drop of the preferred cycloplegic is placed in each eye,
followed in five minutes by 1 drop of NEO-SYNEPHRINE hydrochloride 2.5 percent
ophthalmic solution and in ten minutes by another drop of the cycloplegic. In
50 to 60 minutes, the eyes are ready for refraction.
For children, a drop of atropine sulfate 1 percent is placed in each
eye, followed in 10 to 15 minutes by 1 drop of NEO-SYNEPHRINE hydrochloride
2.5 percent ophthalmic solution and in five to ten minutes by a second drop
of atropine sulfate 1 percent. In one to two hours, the eyes are ready for refraction.
For a “one application method,” NEO-SYNEPHRINE hydrochloride 2.5 percent ophthalmic
solution may be combined with a cycloplegic to elicit synergistic action. The
additive effect varies depending on the patient. Therefore, when using a “one
application method,” it may be desirable to increase the concentration of the
cycloplegic.
Ophthalmoscopic Examination
One drop of NEO-SYNEPHRINE hydrochloride 2.5 percent ophthalmic solution is
placed in each eye. Sufficient mydriasis to permit examination is produced in
15 to 30 minutes. Dilatation lasts from one to three hours.
Diagnostic Procedures
Provocative Test for Angle Block in Patients with Glaucoma:
The 2.5 percent ophthalmic solution may be used as a provocative test when
latent increased intraocular pressure is suspected. Tension is measured before
application of NEO-SYNEPHRINE hydrochloride and again after dilatation. A 3
to 5 mm of mercury rise in pressure suggests the presence of angle block in
patients with glaucoma; however, failure to obtain such a rise does not preclude
the presence of glaucoma from other causes.
Shadow Test (Retinoscopy): When dilatation of the pupil without
cycloplegic action is desired for the shadow test, the 2.5 percent ophthalmic
solution may be used alone.
Blanching Test: One or 2 drops of the 2.5 percent ophthalmic
solution should be applied to the injected eye. After five minutes, examine
for perilimbal blanching. If blanching occurs, the congestion is superficial
and probably does not indicate iritis.
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