Journal Article

Mydriasis mediated by local anesthetics: an unexpected adverse event or new therapeutic indication?

Contreras-Salinas, Homero, Olvera-Montaño, Oscar, Romero-López, María Soledad, Vázquez-Beltrán, Janet Cristina, Rodríguez-Herrera, Lourdes Yolotzin

2025

Overview

The increasing off-label use of medications needs a robust pharmacovigilance system. This is particularly crucial given the abundance of scientific data that can be harnessed to ensure a product’s safety. Our review focuses on the off-label use of local anesthetics, a common practice in topical and intracameral applications. However, the occurrence of mydriasis, as indicated in the monographs/summaries of product characteristics, is an unexpected adverse event. Our aim is to provide a comprehensive understanding of mydriasis caused by local anesthetics, both as an unexpected adverse event and as an off-label use, to reinforce the importance of pharmacovigilance practices. We conducted a comprehensive search in Medline/PubMed and Google Scholar from two distinct perspectives: examining the occurrence of mydriasis with the use of local anesthetic as an adverse event and as an off-label use. Our search yielded 14 articles that reported mydriasis as an unexpected adverse event with the use of anesthetics, with dental procedures being a significant contributor to this type of event. Also, we identified eight articles that explored the off-label use of local anesthetics to induce mydriasis, with the most common method of drug administration being intracameral injection. These findings underscore the importance of our research in understanding the unexpected adverse event of mydriasis and the potential for off-label use of local anesthetics. They also highlight the need for continued involvement and vigilance in this area, as our understanding of these phenomena continues to evolve and further investigation is crucial. The use of local anesthetics for mydriasis holds significant promise, particularly in ophthalmological surgeries. This approach could potentially mitigate the adverse events associated with conventional mydriatics, offering a more efficient and safer alternative. Furthermore, using a single medication for akinesia, anesthesia, and mydriasis could significantly enhance the efficiency and convenience of surgical procedures. On the other hand, it is crucial to extend the knowledge of the mydriasis-anesthesia association through risk minimization activities (e.g., the inclusion of monographs/summary of product characteristics) to communicate the risk of mydriasis with the use of local anesthetics. Plain language summary Is mydriasis an unexpected adverse event induced by local anesthetics, or could it indicate a new therapeutic use? Why was the study done? Unknown side effects of drugs can lead to undesired effects, but in some cases, they can lead to the discovery of beneficial effects that could significantly improve patient health. What did the researchers do? We searched the literature in Medline/PubMed and Google Scholar from two perspectives on the presence of mydriasis with the use of local anesthetic as an undesired and beneficial effect. What did the researchers find? This review has found several cases of undesired mydriasis caused by local anesthetics. However, it is essential to note that their beneficial use as mydriatic is also commonly observed in topical and intracameral applications, especially in ophthalmic surgeries. What do the findings mean? Although mydriasis could be considered an undesired event in some therapeutic interventions, this review considers the potential use of local anesthetics to induce mydriasis since it represents a promising new therapeutic indication that interests the medical community, particularly given their frequent use in ophthalmological surgeries.

• Publisher: SAGE Publications,Sage Publications Ltd,SAGE Publishing
• Subject: Anesthesia / Pharmacovigilance / Review / Surgery