Pupil dilation using a pledget sponge: a randomized controlled trial

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To show that a pledget soaked in mydriatics and placed in the lower conjunctival fornix is as effective as drops in providing mydriasis for cataract surgery.


A randomized, masked, controlled trial of 56 patients assigned to either a pledget group (n = 25) or a control eye drops group (n = 31) was carried out. Controls had the routine practice of repeated topical mydriatic drops: tropicamide, phenylepherine and atropine. The trial group had a 3-mm pledget trimmed, soaked in mydriatics and placed in the inferior fornix for 20 min. Pupil diameter was measured using a photographic technique with a standard scale shown in each picture. Two masked observers measured the pupils using the scale of the ruler in the developed photograph. All patients completed a 0–10 stinging score prior to surgery.


There were no complications. The mean pupil diameter in the control group was 7.23 (6.91–7.94 95% confidence intervals [CI]) and 7.44 (6.96–7.92 95% CI) in the pledget group. There was no statistically significant difference in pupil diameter between the two groups: difference between means 0.21 (−0.32 to 0.75 95% CI) and Student's t-test of the difference between means (t = 0.8 and two-tailed) probability P = 0.43. There was no significant difference in the stinging scores: Mann–Whitney test P = 0.69.


The use of a pledget cellulose sponge to deliver mydriatics prior to cataract surgery is as effective as the conventional method of repeated drop administration and was not associated with any adverse effects.

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