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As this child has significant hypermetropia on retinoscopy, a cycloplegic refraction should be performed. Commonly used is 1 per cent cyclopentolate hydrochloride, which should be instilled at least 30 minutes before retinoscopy. Although a relatively safe cycloplegic without many side effects, it can leave 1-1.5D of residual accommodation. Some authors suggest this can be eliminated by using three drops separated by 10-minute intervals.1 However, practitioners will appreciate the difficulties sometimes encountered instilling even one drop in each eye. The amount of correction that should be prescribed is discussed later. Once the patient in this case study is prescribed spectacles, their ocular motor balance should be reassessed.
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