Mydrane (Lidocaine Hydrochloride Monohydrate, Phenylephrine Hydrochloride, Tropicamide)

Mydrane is a combination ophthalmic drug used to achieve mydriasis and analgesia during intra‑ocular procedures.

• Cataract surgery: produces pupil dilation and intra‑ocular analgesia to improve surgical access.
• Intra‑ocular lens implantation: facilitates clear visualization of the anterior segment for accurate lens placement.
• Other intra‑ocular procedures: ensures adequate mydriasis and analgesia for procedures such as trabeculectomy or vitrectomy.

• Lidocaine blocks voltage‑gated sodium channels in ocular nerves, producing rapid local anesthesia. Phenylephrine activates alpha‑1 adrenergic receptors on the iris dilator muscle, causing contraction and pupil dilation. Tropicamide antagonizes muscarinic receptors in the iris sphincter and ciliary body, leading to cycloplegia and additional mydriasis. The combined actions result in a dilated, anesthetized eye suitable for intra‑ocular surgery.

Mydrane may cause ocular and systemic reactions after intracameral administration.

Common Side Effects

• Transient ocular pain or discomfort.
• Temporary increase in intra‑ocular pressure.
• Corneal edema or mild haze.
• Blurred vision lasting a few hours.
• Conjunctival hyperemia.
• Mild anterior chamber reaction.

Serious or Rare Side Effects

• Severe allergic reaction or anaphylaxis.
• Persistent or uncontrolled mydriasis.
• Sustained intra‑ocular pressure elevation requiring intervention.
• Endophthalmitis or intra‑ocular infection.
• Retinal detachment or other vision‑threatening events.

Prior to Mydrane use, clinicians should evaluate ocular health and systemic conditions that may affect safety.

• Hypersensitivity assessment: avoid in patients with known allergy to any component.
• Intra‑ocular pressure monitoring: check baseline pressure and observe post‑administration.
• Cardiovascular caution: phenylephrine may raise systemic blood pressure; use carefully in hypertensive patients.
• Narrow‑angle glaucoma: avoid or use with extreme caution due to risk of angle closure.
• Sterile technique: ensure aseptic preparation and administration to prevent infection.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake.

Mydrane can interact with systemic and ocular agents that affect pupil size, blood pressure, or anesthetic depth.

Major Interactions (Avoid)

• Systemic alpha‑adrenergic agonists (e.g., norepinephrine) – may cause excessive hypertension.
• Concurrent strong mydriatics – can lead to prolonged dilation and angle‑closure risk.
• Other local anesthetics – additive neurotoxicity.

Moderate Interactions (Monitor Closely)

• Antihypertensive medications – phenylephrine may diminish their effect.
• Anticholinergic drugs (e.g., atropine) – may enhance cycloplegic effect.
• Beta‑blocker eye drops – possible additive intra‑ocular pressure changes.