title: Acute psychotic reaction caused by topical cyclopentolate use for cycloplegic refraction before refractive surgery: case report and review of the literature.
abstract: A 56-year-old woman was evaluated for the surgical correction of hyperopia (+3.0 diopters). Two drops of cyclopentolate 1% were instilled in both eyes for measurement of the cycloplegic refraction and wavefront analysis. Immediately after the second instillation, the patient reported drowsiness, dizziness, nausea, and fatigue. Ten minutes later, stimulatory central nervous system symptoms in the form of restlessness, cheerfulness, and a 20-minute-long roar of laughter were observed, interrupted by a new sedative phase. Basic medical and neurologic examinations were unremarkable except for gait ataxia. Four hours later, the examination was continued uneventfully. As surgical treatment of refractive errors and measurement of cycloplegic refraction using cyclopentolate become more frequent, ophthalmologists should be aware of this unusual acute event.
authors.affiliation: Department of Ophthalmology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
authors.forename: Alireza
authors.initials: A
authors.lastname: Mirshahi
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohnen
mesh_terms: D000208:Acute Disease; D003519:Cyclopentolate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ; D008875:Middle Aged; D009184:Mydriatics / Q000008:administration & dosage / Q000009:adverse effects*; D009883:Ophthalmic Solutions; D011300:Preoperative Care; D011605:Psychoses, Substance-Induced / Q000209:etiology*; D011680:Pupil / Q000187:drug effects
chemical_list: D009184:Mydriatics; D009883:Ophthalmic Solutions; D003519:Cyclopentolate