Mydrane (Lidocaine Hydrochloride Monohydrate, Phenylephrine Hydrochloride, Tropicamide)

Mydrane is used intra‑operatively to achieve pupil dilation and anesthesia in anterior segment ocular procedures.

• Cataract surgery: provides rapid pupil dilation and intra‑ocular anesthesia facilitating lens removal.
• Anterior segment surgery: enables adequate mydriasis and analgesia for procedures such as trabeculectomy or iridotomy.
• Intra‑ocular lens implantation: ensures a stable, dilated pupil and comfort during lens placement.
• Combined phaco‑emulsification procedures: supports simultaneous dilation and anesthesia for efficient surgery.

• Mydrane combines three agents that act on distinct ocular targets. Lidocaine blocks voltage‑gated sodium channels in corneal and conjunctival nerves, producing rapid local anesthesia. Phenylephrine stimulates α1‑adrenergic receptors on the dilator pupillae muscle, causing contraction and pupil enlargement. Tropicamide antagonizes muscarinic receptors in the sphincter pupillae muscle, leading to relaxation and further dilation. The synergistic effect yields prompt mydriasis and analgesia within seconds of intracameral injection.

Mydrane may be associated with ocular and systemic adverse reactions following intracameral administration.

Common Side Effects

• Transient ocular discomfort: mild irritation or burning sensation at the injection site.
• Temporary blurred vision: short‑term reduction in visual acuity that resolves as the drug disperses.
• Mild conjunctival hyperemia: slight redness of the eye that typically subsides within hours.
• Slight increase in intra‑ocular pressure: transient rise that normalizes without intervention.

Serious or Rare Side Effects

• Allergic reaction: signs such as swelling, rash, or anaphylaxis requiring immediate medical attention.
• Persistent mydriasis: prolonged pupil dilation that may affect vision.
• Corneal endothelial toxicity: rare damage to corneal cells leading to edema.
• Endophthalmitis: serious intra‑ocular infection, though extremely uncommon.

Before using Mydrane, clinicians should consider several precautionary measures to minimize risk.

• Patient assessment: evaluate for known hypersensitivity to lidocaine, phenylephrine, tropicamide or any component.
• Cardiovascular status: avoid use in patients with uncontrolled hypertension or severe cardiac disease due to phenylephrine effects.
• Intra‑ocular pressure monitoring: check baseline pressure and monitor after injection, especially in glaucoma patients.
• Pregnancy and lactation: use only if the potential benefit justifies the potential risk, as safety data are limited.
• Drug interactions: review concomitant ocular medications that may potentiate mydriasis or affect hemodynamics.
• Store at ambient temperature: keep the vial below 25 °C, protected from light and moisture in the original packaging.

Mydrane can interact with other agents that influence ocular tone or systemic cardiovascular responses.

Major Interactions (Avoid)

• Systemic sympathomimetics: concurrent use may cause excessive hypertension or tachycardia.
• Other mydriatics: additive pupil dilation can increase risk of acute angle‑closure glaucoma.

Moderate Interactions (Monitor Closely)

• Topical beta‑blockers: may blunt phenylephrine‑induced rise in intra‑ocular pressure.
• Anticholinergic drugs: combined effect can intensify mydriasis and cycloplegia.
• Intra‑ocular antibiotics: monitor for potential changes in ocular surface pH affecting drug stability.