Mydrane (Lidocaine Hydrochloride Monohydrate, Phenylephrine Hydrochloride, Tropicamide)

Mydrane is used in ophthalmic procedures to achieve rapid mydriasis and intra‑ocular anesthesia.

• Cataract surgery: provides pupil dilation and analgesia to facilitate lens removal.
• Vitrectomy and other intra‑ocular surgeries: enables quick mydriasis and pain control for optimal operative field.
• Diagnostic ocular examinations requiring dilation: creates a clear view of intra‑ocular structures for accurate assessment.
• Posterior capsular opacification (YAG) laser treatment: ensures adequate pupil size for laser access.
• Glaucoma filtration surgery: provides analgesia and dilation to improve surgical exposure.

• Lidocaine blocks voltage‑gated sodium channels in ocular nerve fibers, producing rapid local anesthesia. Phenylephrine acts as an α1‑adrenergic agonist, contracting the dilator pupillae muscle to produce mydriasis. Tropicamide is an antimuscarinic agent that relaxes the sphincter pupillae muscle, enhancing pupil dilation and providing cycloplegia. The combined action yields simultaneous anesthesia and sustained dilation of the pupil during intra‑ocular surgery.

Mydrane may cause ocular and systemic reactions following intracameral administration.

Common Side Effects

• Transient ocular pain: mild discomfort that resolves within minutes.
• Temporary increase in intra‑ocular pressure: usually self‑limiting.
• Blurred vision: short‑lasting visual disturbance after the procedure.
• Conjunctival hyperemia: mild redness of the eye.

Serious or Rare Side Effects

• Severe allergic reaction (anaphylaxis): requires immediate medical attention.
• Persistent mydriasis: prolonged pupil dilation beyond expected duration.
• Endophthalmitis: intra‑ocular infection that can threaten vision.

When using Mydrane, consider the following precautions.

• Allergy assessment: verify patient has no known hypersensitivity to lidocaine, phenylephrine, or tropicamide.
• Intra‑ocular pressure monitoring: measure IOP before and after injection, especially in glaucoma patients.
• Cardiovascular caution: use carefully in patients with uncontrolled hypertension or coronary disease due to phenylephrine systemic absorption.
• Narrow‑angle glaucoma avoidance: avoid or use with extreme caution in eyes at risk of angle‑closure.
• Sterile technique: ensure aseptic preparation and injection to prevent infection.
• Store at 2‑8°C: keep refrigerated, protect from light, do not freeze or shake.

Mydrane may interact with other medicines; review the following.

Major Interactions (Avoid)

• MAO inhibitors: phenylephrine may cause hypertensive crisis when combined.
• Beta‑blockers: may mask phenylephrine‑induced tachycardia, altering hemodynamic response.
• Systemic sympathomimetics (e.g., epinephrine): additive pressor effects increase risk of hypertension.

Moderate Interactions (Monitor Closely)

• Anticholinergic drugs: concurrent use may enhance cycloplegic effect of tropicamide.
• Other ocular anesthetics: combined use may increase risk of corneal toxicity.
• Systemic vasoconstrictors: may potentiate phenylephrine’s vascular effects.