Abstract
Aim: Anisocoria may be the first sign of life-threatening intracranial events, or it may manifest as a side effect of commonly used drugs. While systemic use of pharmacological agents such as atropine, scopolamine, and amphetamine usually causes bilateral mydriasis, unilateral mydriasis can be observed with direct contact of ipratropium bromide which is used with nebulizer, to the eye. Here, we present a case that developed anisocoria due to pharmacological agents.
Case: A 12-year-old male patient with a history of cerebral palsy who had undergone antireflux surgery was being followed up in pediatric surgery ward due to lower respiratory tract infection. While nebulizer and antibiotherapy were continuing, newly developed anisocoria it was noticed on physical examination. After a detailed history and physical examination, no intracranial event was noted to explain anisocoria. Considering that the ipratropium bromide treatment caused anisocoria, nebulizer treatment was discontinued. After discontinuation of treatment, anisocoria resolved within 24 hours.
Conclusion: Although intracranial events are considered in the etiology, it should be kept in mind that frequently used pharmacological agents such as ipratropium bromide may cause anisocoria. It is emphasized that when anisocoria is encountered, unnecessary imaging and further examinations can be avoided together with careful systemic examination and a detailed history of the patient.
Keywords
References
- Pennington KM, St Louis EK. "Don't Believe Your Eyes" Ipratropium Induced Mydriasis: A Case Report and Review of the Literature. Gen Med (Los Angel). 2016;4(3):255. doi:10.4172/2327-5146.1000255
- Gross JR, McClelland CM, Lee MS. An approach to anisocoria. Curr Opin Ophthalmol. 2016;27(6):486-492. doi:10.1097/ICU.0000000000000316
- Lee AG, Taber KH, Hayman LA, Tang RA. A guide to the isolated dilated pupil. Arch Fam Med. 1997;6(4):385-388. doi:10.1001/archfami.6.4
- Polomsky M, Smereck J. Unilateral mydriasis due to hemorrhoidal ointment. J Emerg Med. 2012;43(1):e11-e15. doi:10.1016/j.jemermed.2009.05.018
- Firestone D, Sloane C. Not your everyday anisocoria: angel's trumpet ocular toxicity. J Emerg Med. 2007;33(1):21-24. doi:10.1016/j.jemermed.2007.02.046
- Iosson N. Images in clinical medicine. Nebulizer-associated anisocoria. N Engl J Med. 2006;354(9):e8. doi:10.1056/NEJMicm050851
- Günaydın YK, Yıldız CG, Işıkoğlu V ve ark. Datura Stramonium Poisoning: Two Case Reports. Journal of Emergency Medicine Case Reports. 2017; 8(1): 4-6.
- Izadi S, Choudhary A, Newman W. Mydriasis and accommodative failure from exposure to topical glycopyrrolate used in hyperhidrosis. J Neuroophthalmol. 2006;26(3):232-233. doi:10.1097/01.wno.0000235577.72427.84
- Hannon B, Jennings V, Twomey M, O'Reilly M. Transdermal hyoscine induced unilateral mydriasis. BMJ Case Rep. 2012;2012:bcr0820114697. Published 2012 Mar 20. doi:10.1136/bcr.08.2011.4697
- Chaudhry P, Friedman DI, Yu W. Unilateral pupillary mydriasis from nebulized ipratropium bromide: A false sign of brain herniation in the intensive care unit. Indian J Crit Care Med. 2014;18(3):176-177. doi:10.4103/0972-5229.128710
- Portran P, Cour M, Hernu R, de la Salle S, Argaud L. Pupillary abnormalities in non-selected critically ill patients: an observational study. J Thorac Dis. 2017;9(8):2528-2533. doi:10.21037/jtd.2017.07.58
- Wehbe E, Antoun SA, Moussa J, Nassif I. Transient anisocoria caused by aerosolized ipratropium bromide exposure from an ill-fitting face mask. J Neuroophthalmol. 2008;28(3):236-237. doi:10.1097/WNO.0b013e318175cb94
Abstract
Amaç: Anizokori, hayatı tehdit eden kafa içi hadiselerin ilk habercisi olabileceği gibi, sık kullanılan ilaçların yan etkisi olarak da karşımıza çıkabilir. Atropin, skopolamin, amfetamin gibi farmakolojik ajanların sistemik kullanımı genellikle bilateral midriazise yol açarken, nebulizatör ile kullanılan ipratropium bromürün göze direkt teması ile tek taraflı midriazis izlenebilir. Bu yazıda, farmakolojik ajana bağlı anizokori gelişen bir vakayı sunuyoruz.
Olgu: Serebral palsi nedeni ile takip edilen 12 yaşında erkek hasta, antireflü operasyonu sonrası akciğer enfeksiyonu nedeni ile çocuk cerrahisi servisinde izleme alındı. Nebül tedavileri ve antibiyoterapisi devam etmekte iken fizik muayenede yeni gelişen anizokori tespit edildi. Ayrıntılı öykü ve fizik muayene sonrası anizoriyi açıklayacak intrakranial bir olay tespit edilmedi. İpratropium bromür ile nebül tedavisinin anizokoriye neden olduğu düşünülerek, nebül tedavisi kesildi. Tedavinin kesilmesinin ardından anizokori 24 saat içinde düzeldi.
Sonuç: Anizokori etiyolojisinde, intrakranial hadiseler ilk olarak akla gelse de ipratropium bromür gibi sık kullanılan farmakolojik ajanların anizokoriye neden olabileceği unutulmamalıdır. Anizokori ile karşılaşıldığında sistemik muayene ve klinik ile beraber gereksiz görüntüleme ve ileri tetkiklerin yapılmasının önüne geçilebileceği vurgulanmak istenmiştir.
Keywords
References
- Pennington KM, St Louis EK. "Don't Believe Your Eyes" Ipratropium Induced Mydriasis: A Case Report and Review of the Literature. Gen Med (Los Angel). 2016;4(3):255. doi:10.4172/2327-5146.1000255
- Gross JR, McClelland CM, Lee MS. An approach to anisocoria. Curr Opin Ophthalmol. 2016;27(6):486-492. doi:10.1097/ICU.0000000000000316
- Lee AG, Taber KH, Hayman LA, Tang RA. A guide to the isolated dilated pupil. Arch Fam Med. 1997;6(4):385-388. doi:10.1001/archfami.6.4
- Polomsky M, Smereck J. Unilateral mydriasis due to hemorrhoidal ointment. J Emerg Med. 2012;43(1):e11-e15. doi:10.1016/j.jemermed.2009.05.018
- Firestone D, Sloane C. Not your everyday anisocoria: angel's trumpet ocular toxicity. J Emerg Med. 2007;33(1):21-24. doi:10.1016/j.jemermed.2007.02.046
- Iosson N. Images in clinical medicine. Nebulizer-associated anisocoria. N Engl J Med. 2006;354(9):e8. doi:10.1056/NEJMicm050851
- Günaydın YK, Yıldız CG, Işıkoğlu V ve ark. Datura Stramonium Poisoning: Two Case Reports. Journal of Emergency Medicine Case Reports. 2017; 8(1): 4-6.
- Izadi S, Choudhary A, Newman W. Mydriasis and accommodative failure from exposure to topical glycopyrrolate used in hyperhidrosis. J Neuroophthalmol. 2006;26(3):232-233. doi:10.1097/01.wno.0000235577.72427.84
- Hannon B, Jennings V, Twomey M, O'Reilly M. Transdermal hyoscine induced unilateral mydriasis. BMJ Case Rep. 2012;2012:bcr0820114697. Published 2012 Mar 20. doi:10.1136/bcr.08.2011.4697
- Chaudhry P, Friedman DI, Yu W. Unilateral pupillary mydriasis from nebulized ipratropium bromide: A false sign of brain herniation in the intensive care unit. Indian J Crit Care Med. 2014;18(3):176-177. doi:10.4103/0972-5229.128710
- Portran P, Cour M, Hernu R, de la Salle S, Argaud L. Pupillary abnormalities in non-selected critically ill patients: an observational study. J Thorac Dis. 2017;9(8):2528-2533. doi:10.21037/jtd.2017.07.58
- Wehbe E, Antoun SA, Moussa J, Nassif I. Transient anisocoria caused by aerosolized ipratropium bromide exposure from an ill-fitting face mask. J Neuroophthalmol. 2008;28(3):236-237. doi:10.1097/WNO.0b013e318175cb94
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Case Report |
| Authors | |
| Early Pub Date | July 4, 2023 |
| Publication Date | June 30, 2023 |
| Published in Issue | Year 2023 Volume: 6 Issue: 2 |
