Which agent breaks posterior synechiae and decreases ocular inflammation pain?

• A. Atropine 1%
• B. Homatropine 2%
• C. Tropicamide 1%
• D. Cyclopentolate 1%

Answer: (A)

In this situation you want a strong, long-lasting cycloplegic that can both dilate the pupil enough to break adhesions (posterior synechiae) and reduce ciliary muscle spasm to lessen pain. Atropine fits that need: it produces very robust mydriasis and complete cycloplegia with a long duration, which helps physically separate iris from the lens and relaxes the inflamed ciliary muscle, decreasing pain from the uveitis. The other agents are either shorter-acting or provide weaker cycloplegia, so they’re less reliable for breaking established synechiae and for sustained pain relief. Tropicamide and cyclopentolate give only temporary dilation and cycloplegia, while homatropine is less potent and longer-acting than tropicamide but still not as strong as atropine for this purpose.