Recently, a group of Canadian pediatric rheumatologists, pediatric ophthalmologists and patients and parents have been working together to develop standardized approaches for monitoring and treating children with uveitis associated with JIA.  It was felt important to develop standardized approaches because there is some variability in how children with JIA uveitis are managed. The specific question about when and if cyclogyl should be used was not part of our discussions but I can make some comments in response to this question.

First, I think it would be advisable to ask each of the ophthalmologists your question so you have a clear understanding about the rationale for their respective approaches.  However, while I am not an ophthalmologist, I do have some thoughts about why there might be differences in approaches.

Cyclogyl is used to dilate the pupil of the eye – that is to make the pupil bigger and stay bigger for the duration of the exam. The pupil appears enlarged when it is dilated because the iris tissue moves outward (and the pupil appears small when it constricts because the iris moves inward to the centre of the eye). By dilating the eye the doctor will have a much wider window to look through into the eye making the eye examination easier.  However, once the pupil is dilated an accurate test for vision cannot be done as the effects of the medication can cause blurring of this vision that may last for up to 24 hrs. Also, when the pupils are dilated with cylogyl it is not possible to accurately assess the movement of the iris; sometimes when the iris becomes inflamed, as it does in uveitis, parts of the iris can get stuck down to the lens behind or the cornea in the front; when this binding of the iris to adjacent tissues occurs,  these areas of attachment might be less apparent than when the pupil is constricted (gets smaller). When the pupil is dilated with cyclogyl drops it won’t move to the constricted position so that it is more difficult to assess areas where the iris might be attached to the adjacent structures.   So, one approach is for the ophthalmologist to have the vision exam and iris movement assessments done without using the dilating eye drops then add the eyedrops later to enlarge the pupil to make the visualization examination of eye with the slit lamp easier.