Mydrane (Lidocaine Hydrochloride Monohydrate, Phenylephrine Hydrochloride, Tropicamide)

Mydrane is used intraoperatively to achieve mydriasis and analgesia in ophthalmic procedures, particularly cataract extraction.

• Cataract surgery: rapid pupil dilation and intra‑operative analgesia.
• Intraocular lens implantation: facilitates visualization and patient comfort.
• Anterior segment surgeries: provides adequate mydriasis and reduces intra‑operative pain.

• Mydrane combines three agents that act synergistically within the eye. Lidocaine blocks voltage‑gated sodium channels, producing local anesthesia of ocular tissues. Phenylephrine stimulates α1‑adrenergic receptors on the dilator pupillae muscle, causing contraction and pupil dilation. Tropicamide antagonizes muscarinic receptors on the sphincter pupillae muscle, leading to relaxation and further dilation, resulting in rapid, sustained mydriasis and analgesia during surgery.

Mydrane may cause ocular and systemic reactions after intracameral administration.

Common Side Effects

• Transient ocular discomfort or burning sensation.
• Mild conjunctival hyperemia (redness).
• Temporary increase in intraocular pressure.
• Brief blurred vision after the procedure.

Serious or Rare Side Effects

• Severe allergic reaction, including anaphylaxis.
• Persistent mydriasis lasting more than 24 hours.
• Corneal endothelial toxicity leading to corneal edema.

Mydrane should be used with careful patient assessment and monitoring.

• Allergy assessment: confirm no known hypersensitivity to lidocaine, phenylephrine, or tropicamide.
• Narrow‑angle glaucoma: avoid use due to risk of acute angle‑closure.
• Cardiovascular disease: use cautiously as phenylephrine may raise systemic blood pressure.
• Post‑operative monitoring: check intraocular pressure and pupil size after surgery.
• Drug interactions: review concomitant ocular medications that may affect pupil dynamics.
• Store at controlled room temperature: keep in original container, protect from light and moisture.

Mydrane may interact with other ocular or systemic agents.

Major Interactions (Avoid)

• Concurrent use of additional mydriatic agents may cause excessive dilation and iris damage.
• Systemic phenylephrine with MAO inhibitors or tricyclic antidepressants can precipitate hypertensive crisis.
• Co‑administration with other local anesthetics may increase risk of lidocaine toxicity.

Moderate Interactions (Monitor Closely)

• Beta‑blocker eye drops may blunt phenylephrine‑induced dilation.
• Cholinergic agents (e.g., pilocarpine) can reduce tropicamide effectiveness.
• Intra‑ocular pressure‑lowering drugs may alter the expected pressure response after Mydrane.