An elderly woman receives the antimuscarinic agent cyclopento-late topically as eye drops for refraction during an eye exam. What represents a contraindication for this procedure?

Question

A. Bradycardia.
B. Urinary incontinence.
C. Asthma.
D. Narrow ocular angles.
E. Peptic ulcer.

Answer 1

The correct answer here is D. Narrow ocular angles.

Antimuscarinic agents like cyclopentolate can cause pupil dilation (mydriasis) and paralysis of the ciliary muscle (cycloplegia). In individuals with narrow angles, dilation of the pupil can lead to an acute glaucoma attack due to the increased intraocular pressure from blockage of the aqueous humor outflow.

Other options:

• A. Bradycardia: While antimuscarinics can cause tachycardia, bradycardia itself is not a contraindication for dilating the pupil.
• B. Urinary incontinence: Antimuscarinics can actually help in this condition but are not contraindicated.
• C. Asthma: While caution may be warranted due to potential bronchial effects, asthma itself is not a strict contraindication.
• E. Peptic ulcer: Antimuscarinics can reduce gastric secretions but are not contraindicated in the procedure.

Therefore, the most significant contraindication in this scenario given the use of cyclopentolate is narrow ocular angles.