Lower conjunctival fornix packing for mydriasis in premature infants: a randomized trial

Objective: To compare the mydriatic effect of lower conjunctival fornix packing to conventional instillation of eyedrops containing 2.5% phenylephrine and 1% tropicamide in premature infants undergoing examination for retinopathy of prematurity. Methods: The patients were randomized to receive either conventional instillation of mydriatic drops or lower conjunctival fornix packing in one eye and the alternate method in the fellow eye. For the eyes receiving lower conjunctival fornix packing (study group), one small piece of the cotton wool soaked with one drop of 2.5% phenylephrine and one drop of 1% tropicamide was packed in the lower conjunctival fornix for 15 minutes. For the eyes receiving the conventional instillation (control group), 2.5% phenylephrine and 1% tropicamide were alternately instilled every 5 minutes for two doses each. Horizontal pupil diameter was measured with a ruler in millimeters 40 minutes later. Results: The mean dilated pupil diameter in study group and control group were 5.76 +/- 1.01 mm and 4.50 +/- 1.08 mm, respectively. This difference was statistically significant (P < 0.05). Conclusion: The dilated pupil diameter after receiving the lower conjunctival fornix packing was larger than conventional instillation with a statistically significant difference. We recommended the packing method to dilate the preterm infant pupil, especially if the pupil is difficult to dilate.