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Ephraim Friedman, MD
JAMA. 1968;205(13):928-929. doi:10.1001/jama.1968.03140390052016.
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It is generally accepted that examination of the ocular fundus is an important part of a complete physical examination. An adequate examination through an undilated pupil is, however, difficult, and significant systemic and ocular disease often goes unrecognized. Most physicians, wary of precipitating acute glaucoma are, therefore, reluctant to dilate the pupil in order to facilitate ophthalmoscopy. This is the unfortunate result of a lack of understanding of the natural history of angle closure glaucoma and confusion as to the difference between open angle glaucoma and angle closure glaucoma.

The more common of the two diseases, open angle glaucoma, is chronic, asymptomatic, and a major cause of blindness. It is not seriously affected by mydriatic drops instilled for a single examination. Angle closure glaucoma, a much less common disease, characterized by acute episodes of pain and blurred vision, can be precipitated by dilating the pupil. These attacks, whether spontaneous or


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