Oxyphenonium as an atropine substitute in ophthalmology.

ATROPINE, perhaps the drug most used in ophthalmology, is prone to cause contact-irritation, often at a time when continued mydriasis is essential, in patients on long-term treatment. Unfortunately, most substitutes are less effective in producing mydriasis, and not infrequently contact-irritation is developed to these substitutes in rapid succession. Lachescine (E3) was developed in Great Britain during the war because of the possibility of a serious shortage of the usual mydriatics. It was found to have an effect mid-way between that of atropine and homatropine with cocaine. Since this time, Lachescine has been found very useful in clinical practice where atropine irritation has occurred. Its difference from the atropine group of mydriatics (Figure) made it almost free from producing irritation. Its usefulness in cases of atropine sensitivity has been suggested in recent ophthalmic text-books, and, in her original article on this subject, Mann (1946) reviews 42 cases of atropine irritation.