title: Systemic toxicity from ocular homatropine.
abstract: Toxidromes are well known to emergency physicians. An unclear or incomplete history and subtle findings on physical examination make the diagnosis of poisonings challenging. This article reports a patient who had an acute onset of visual hallucinations, pressured speech, and mania. Although she denied taking any medications, she was ultimately diagnosed as having anticholinergic toxicity. On further questioning of family members, it was discovered that she was being treated for anterior uveitis with 5% homatropine. This case illustrates the potential role of ocular medications in systemic toxicity. Patients often do not consider eyedrops to be medications, and their use may be overlooked in the medical history. It also is important to educate patients and medical staff in methods to minimize systemic toxicity when using ocular medication.
authors.affiliation: Albany Medical Center, Department of Emergency Medicine, NY 12208, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Reilly
authors.forename: L
authors.initials: L
authors.lastname: Chan
authors.forename: N J
authors.initials: NJ
authors.lastname: Mehta
authors.forename: R F
authors.initials: RF
authors.lastname: Salluzzo
mesh_terms: D000208:Acute Disease; D001714:Bipolar Disorder / Q000139:chemically induced*; D062787:Drug Overdose / Q000517:prevention & control; D004635:Emergency Medicine; D005260:Female; D006212:Hallucinations / Q000139:chemically induced*; D006801:Humans; D007322:Instillation, Drug; D008508:Medication Errors; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010276:Parasympatholytics / Q000506:poisoning*; D014326:Tropanes / Q000506:poisoning*; D014606:Uveitis, Anterior / Q000188:drug therapy*
chemical_list: D009883:Ophthalmic Solutions; D010276:Parasympatholytics; D014326:Tropanes; C100236:homatropine