IP Requirement: Emory IP

Experience Requirement:

– Mechanical Design

– Rapid Prototyping

Background 

Eye drops for pupillary dilation are used preoperatively in children undergoing eye examinations under anesthesia.  Infants and babies can be easily held or swaddled in order to apply the eye drops; however, older kids and kids with special needs (autism, sensory processing disorder, etc) may prove to be more difficult.  More often than not, eye drops are unsuccessfully applied preoperatively.  Therefore, eye drops are applied after induction of anesthesia.  The time needed for adequate dilation under general anesthesia extends the total anesthetic time and cost. 

What is the current management? 

Infants and babies are held or swaddled for eye drop application.  Older kids may require an anxiolytic prior to administration of eye drops. Other methods include the following,

1. Getting Drops Onto the Eye: Low-tech Solutions
2. Optejet Technology – Eyenovia
3. Novartis acquires Kedalion Therapeutics and its innovative ocular delivery platform that could transform patient experience | Novartis United States of America

How our device works 

Nebulized ipratropium bromide has been reported in the literature to cause a fixed dilated pupil.1,2   In 2019, Yang et al utilized a novel ocular nebulization delivery system for dry eyes.3

In a 2022 randomized study, Lin et al. used ocular nebulization therapy along with gland massage to treat meibomian gland dysfunction.  They concluded that nebulized eye drops along with massage was superior to just eye drops.4

The device could possibly be glasses/goggles with an inlet (for drops to be placed in) and outlet (exit point for nebulized medication) points.  Once the glasses/googles are on the patient.  The nebulized medication would flow into the glasses/googles.  Distraction methods such as role play can be used such as referring to the nebulized treatment as “we’re walking through a foggy forest.”  Pictures/slides may also be utilized as distractors.   

References 

1. Eustace N, Gardiner C, Eustace P, Marsh B. Nebulised ipratropium causing a unilateral fixed dilated pupil in the critically ill patient: a report of two cases. Crit Care Resusc. 2004 Dec;6(4):268-70.
2. Iosson N.  Nebulizer-Associated Anisocoria.  The New England Journal of Medicine.  2006 Mar;354:e8.
3. Yang, J., Liu, Y., Xu, Y., Li, X., Fu, J., Jiang, X., … Li, X. (2019). A new approach of ocular nebulization with vitamin B12 versus oxytocin for the treatment of dry eye disease: an in vivo confocal microscopy study. "Drug Design, Development and Therapy, 13, 2381–2391.
4. Lin F, Mao X, Ma L, Liu H. An investigation into the effects of ocular nebulization combined with meibomian gland massage on ocular surface status and corneal higher-order aberrations for the treatment of meibomian gland dysfunction. Acta Ophthalmol. 2022 May;100(3):e681-e693.