The three (3) most commonly used medications for pupil dilation are:
Phenylephrine HCL – 2.5% solution
Phenylephrine is the agent used most commonly in decongestants.
When used ophthalmically ”the maternal dose of the medication would be very low and it is not likely to pose a problem for a breastfeeding infant. Due to phenylephrine poor oral bioavailability (38%) it is not likely to produce clinical effects in a breastfed infant unless the maternal dose were quite high” (p874-5)
While there is no data available, Dr. Hale states: “it is unlikely that systemic levels in adults will be sufficient to produce clinically relevant levels in milk. Infants, however should be observed for anticholinergic effects (dry mouth, mydriasis, sedation, tachycardia). A brief waiting period of 3-4 hours would eliminate most risks. (p1081)
Paramed is a combination of 1.0% of hydroxamphetamine hydrobromide and .25% tropicamide.
“The doses used are too low to produce significant systemic levels, and therefore, the amount that enters the milk should likely be too low to produce any untoward effects in the infants. Nevertheless, it is advisable to observe the infant for possible side-effects; a brief with-holding period of 3-4 hours could eliminate most risk.” (p 548)
Hale, Thomas W. (2014) Medications and Mothers’ Milk Hale Publishing Plano, Texas.