Notice of Data Incident


Can a provider refuse to do an eye exam if the patient declines pupil dilation? Or can a provider mandate a patient to do a pupil dilation in order to complete an eye exam? Is this sanctioned by governing boards? The patient is healthy, young, and has no history of eye problems.

It is generally accepted that to do a complete eye exam, the pupil should be dilated. I tell patients that examining the back of the eye without dilation is like trying to examine a room through a keyhole as opposed to opening the door. If a patient has a problem related to the front of the eye such as conjunctivitis (pink eye), then we may not dilate the patient. However, if the patient has a symptom that pertains to the back of the eye, like floaters or symptoms of a retinal detachment, then most ophthalmologist would insist on dilating the pupil. In fact, it could be considered below the standard of care to not do so.

No, a provider cannot mandate a patient to do a pupil dilation but if needed would explain why to the patient. If the patient still refused dilation, the provider would likely document that the patient refused dilation. Pupil dilation is standard practice even in young, healthy patients. Patients of any age could have a serious problem in the back of the eye such as retinal detachment, or melanoma to name a couple of possibilities.
Answered By: Jane C Edmond MD Shared from AAO

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