The pain response to mydriatic eyedrops in preterm infants

J Perinatol. 2013 Jun;33(6):462-5. doi: 10.1038/jp.2012.149. Epub 2012 Dec 13.


Objective: Evaluate physiological and behavioral pain responses of premature infants following instillation of mydriatic eyedrops for retinopathy of prematurity (ROP) examinations. While burning and stinging occurs in older patients, the infant pain response is not well characterized.

Study design: Vital sign and video monitor recorded infant responses before, during and after mydriatic (tropicamide 1%, phenylephrine 2.5%) administration upon first ROP exam. Two masked observers graded Premature Infant Pain Profile (PIPP) scores immediately before and following eyedrop administration. Scores <7 indicate no/minimal pain, 7 to 12 slight/moderate, >12 severe.

Result: Twenty infants had mean premydriatic PIPP score 3.6 (s.d. 1.6), mean postmydriatic score 5.7 (s.d. 3.4), mean change 2.1 (s.d. 3.4) (P=0.01). One (5%) had premydriatic PIPP score ≥7, seven (35%) post scores ≥7 (P=0.07) with one >12.

Conclusion: Mydriatic drops cause a clinically significant pain response in one-third of infants. Non-pharmacological supportive measures are recommended for all infants until predictive factors are defined.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Female
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Male
  • Mydriatics / adverse effects*
  • Ophthalmic Solutions
  • Pain Measurement / methods*
  • Phenylephrine / administration & dosage*
  • Phenylephrine / adverse effects*
  • Philadelphia
  • Prospective Studies
  • Retinopathy of Prematurity / diagnosis*
  • Retinopathy of Prematurity / physiopathology
  • Tropicamide / adverse effects*


  • Mydriatics
  • Ophthalmic Solutions
  • Phenylephrine
  • Tropicamide