Cycloplegic refraction is usually undertaken following instillation of 1% cyclopentolate. Sometimes, other drugs such as cyclopentolate 0.5%, tropicamide or atropine are more appropriate.

Some practitioners advocate cycloplegic refraction for all children on their first eye examination. However, it is probably more appropriate to select certain groups of patients for whom a cycloplegic refraction is essential. Here are my suggestions:

• Those who are poorly cooperative with near or distance retinoscopy.
• Patients with a fluctuating non-cycloplegic retinoscopy reflex.
• Unexplained reduced visual acuity in children.
• Individuals with manifest strabismus, particularly an esotropia.
• Those with significant or unstable esophoria.
• Children with a family history of strabismus, amblyopia or high hyperopia.
• Patients with suspected pseudomyopia.
• Children with a history of strabismus observed by a parent or guardian.
• Children with anisometropia greater than 1.00DS.
• Cases of reduced accommodation.
• In high hyperopia in a child of < 2 years.
• Those with suspected latent hyperopia
• In variable and inconsistent subjective refraction responses.
• Patients with suspected non-organic visual loss.
• In symptoms unrelated to the nature or degree of the manifest refractive error.

In general, the advantages of cycloplegic refraction are:

• Accurate patient fixation is less crucial.
• Accurate retinoscopy can be achieved more easily.
• Latent hyperopia is revealed.
• Refractive error can be confirmed.
• There is a better view of the fundus during ophthalmoscopy.