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Reminder of important clinical lesson
CASE REPORT
Anisocoria secondary to inadvertent contact with scopolamine patch
  1. Janki Shah1,
  2. Alice Jiang1,
  3. Zoltan Fekete2
  1. 1Graduate Medical Education, Orange Regional Medical Center, Middletown, New York, USA
  2. 2Crystal Run Healthcare, Rock Hill, New York, USA
  1. Correspondence to Ms. Janki Shah, jshah4{at}student.touro.edu

Summary

A unilaterally fixed mydriasis, also known as a ‘blown pupil,’ is considered an ominous sign concerning for intracranial pathology. Causes of anisocoria can range from benign to immediately life-threatening. When a patient presents with anisocoria, the concern for a fatal diagnosis leads the clinician to obtain numerous tests, many of which may be unnecessary. The authors present a case of a healthy woman in her 30s who presented with an acute unilateral mydriasis likely secondary to inadvertent contact with a scopolamine patch. On examination, she had no other neurological deficits. Further investigation did not reveal any abnormality. In the event of a patient with an isolated mydriasis in an otherwise healthy and conversant patient with no other neurological deficits, it is essential to rule out other causes before pursuing aggressive and unnecessary testing and treatment.

  • drugs and medicines
  • eye
  • healthcare improvement and patient safety
  • neuroopthalmology
  • occupational and environmental medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2017-221677

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    Footnotes

    • Contributors Each of the listed authors including JS, AJ and ZF, contributed to the conception or design of the work, including the background, differential diagnoses and discussion. They also helped critically revise for important intellectual content. All authors have final approval of the version published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.