Instillation of 5% Povidone-Iodine Ophthalmic Drops Decreases the Respiratory Rate in Children Undergoing Strabismus Surgery: A Randomized Controlled Trial

J Pediatr Ophthalmol Strabismus. 2019 Nov 1;56(6):378-382. doi: 10.3928/01913913-20190923-01.


Purpose: To investigate the effects of topical application of ophthalmic 5% povidone-iodine eye drops, which has been reported to cause apnea in spontaneously breathing children during general anesthesia.

Methods: The authors conducted a randomized, controlled, single-blinded study comparing the effect of balanced salt solution eye drops and povidone-iodine eye drops on respiration in spontaneously breathing children during general anesthesia with sevoflurane via a laryngeal mask airway. Fifty patients received balanced salt solution eye drops and 50 patients received 5% povidone-iodine eye drops.

Results: None of the control patients had a significant change in respiration. Thirty of the 50 (60%) povidone-iodine patients had a slowing of respiration within the first 6 breaths after eye drop instillation (P < .001). The median time of respiratory pause in those 30 patients was 18.5 seconds (range: 4.36 to 96.2 seconds). Among the povidone-iodine patients, children with a history of a prior tonsillectomy and adenoidectomy and/or bilateral myringotomy had a 7.2 times greater chance of experiencing a change in respiration after instillation of the povidone-iodine eye drops.

Conclusions: Topical application of 5% povidone-iodine eye drops causes a slowing and pause in spontaneous ventilation in a majority of children prior to strabismus surgery. This may represent activation of the diving reflex. [J Pediatr Ophthalmol Strabismus. 2019;56(6):378-382.].

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Anesthesia, General / methods
  • Anti-Infective Agents, Local / administration & dosage
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Instillation, Drug
  • Male
  • Ophthalmic Solutions
  • Ophthalmologic Surgical Procedures*
  • Povidone-Iodine / administration & dosage*
  • Preoperative Care / methods*
  • Respiratory Rate / drug effects*
  • Single-Blind Method
  • Strabismus / drug therapy*
  • Strabismus / physiopathology
  • Strabismus / surgery
  • Treatment Outcome


  • Anti-Infective Agents, Local
  • Ophthalmic Solutions
  • Povidone-Iodine