Mydriasis, or excessive dilation of the pupils, can lead to poor vision, photophobia, eye pain, and fatigue. It is often caused by certain drugs or ophthalmic examinations. Traditional treatments like pilocarpine and dapiprazole, while effective, come with systemic side effects and contraindications that limit their use.
In September 2023, the US FDA approved Ryzumvi (phentolamine ophthalmic solution) for treating pharmacologically-induced mydriasis. Ryzumvi works by reversibly binding to alpha-1 adrenergic receptors, effectively reducing pupil diameter without affecting the ciliary muscle. This mechanism allows it to counteract the mydriatic effects of both adrenergic agonists and antimuscarinic drugs.
Clinical trials, including the MIRA series, have demonstrated Ryzumvi's efficacy and safety. The MIRA-2 and MIRA-3 trials showed that Ryzumvi significantly reduced pupil dilation within 60 to 90 minutes post-administration, with effects lasting up to 24 hours. The MIRA-4 trial further supported its use in pediatric patients aged three and older.
Despite its advantages, Ryzumvi is not without limitations. It is contraindicated in patients with active ocular inflammation, such as iritis, due to the risk of iris-lens adhesions. Additionally, precautions are advised for contact lens wearers and to prevent eye injury or contamination during application.
Ryzumvi represents a significant advancement in the treatment of pharmacologically-induced mydriasis, offering a safer, more effective option for patients. Its approval underscores the ongoing progress in ophthalmology and the commitment to addressing a wide range of vision-related disorders.
