Richard P. Wenzel, MD, MSc, MACP, outlined his ideal approach to dilating patients' pupils for a funduscopic exam at his session "Evidence-Based Physical Diagnosis" on Friday morning.
The first step, of course, is to wash your hands, said Dr. Wenzel, who is professor and former chairman of the department of internal medicine at Virginia Commonwealth University in Richmond. Next, with the patient facing the ceiling, cup the lower palpebral sac and administer the eyedrops. Dr. Wenzel's preferred mydriatic is tropicamide, 0.5% or 1%, usually 2 to 3 drops---"I'm very aggressive," he said. The drops should be administered from a distance of 1 inch above the globe, he recommended.
The third step is to have the patient close the eye and allow him or her to blot lightly below the eye to remove any fluid on the face. Last, and very important, place a note at the head of the patient's bed and in the medical record, he said. If you don't, "the nurse may come by and see dilated… pupils and line them up for an MRI," he said. "It doesn't happen often, but it happened to me once when I learned this, a long, long time ago."