title: Prolonged mydriasis after inadvertent topical administration of the calcium channel antagonist amlodipine: implications for glaucoma drug development.
abstract: BACKGROUND
  Calcium channel inhibitors are being investigated as potential therapeutic adjuncts to reduce painful ciliary muscle spasm and control intraocular pressure in glaucoma. Relatively little is known about the effect of topical administration of calcium channel blockers in humans.
  
  
  OBJECTIVE
  (1) To describe prolonged fixed pupil dilation resulting from exposure to topical amlodipine (2) to review the evidence that links calcium channel blockers with mydriasis and (3) to discuss the implications for glaucoma pharmacotherapy.
  
  
  METHODS
  Single interventional case report, literature review (including human and animal studies) and analysis of reported adverse drug reactions (ADRs) records in the USA and UK.
  
  
  METHODS
  A 35-year-old female doctor presented to eye casualty with blurred vision and bilateral, fixed, dilated pupils. A history of exposure to liquid amlodipine while preparing a paediatric chemotherapy regimen for a neuroblastoma patient was elicited. The patient was reassured and observed.
  
  
  RESULTS
  Pupil function returned to normal within 48 h. A multi-national review of adverse drug reactions reports was conducted, as well as an extensive literature search for case reports and experimental studies. To the authors' knowledge this is the first report of amlodipine causing mydriasis and we discuss the potential molecular mechanism.
  
  
  CONCLUSIONS
  This case is the first to suggest that calcium channel blockers can cause prolonged mydriasis. These agents have been investigated as potential adjuncts in glaucoma therapy. As accidental topical exposure to amlodipine can cause prolonged pupil dilation, it could precipitate angle closure in predisposed patients.
authors.affiliation: Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK.
authors.forename: Jonathan C P
authors.initials: JC
authors.lastname: Roos
authors.forename: Anjana S
authors.initials: AS
authors.lastname: Haridas
mesh_terms: D000287:Administration, Topical; D000328:Adult; D017311:Amlodipine / Q000009:adverse effects*; D002121:Calcium Channel Blockers / Q000009:adverse effects*; D005260:Female; D005901:Glaucoma / Q000188:drug therapy; D006801:Humans; D015878:Mydriasis / Q000139:chemically induced*
chemical_list: D002121:Calcium Channel Blockers; D017311:Amlodipine
keywords: Accidental exposure; amlodipine; antagonist; calcium channel blocker; fixed dilated pupil; glaucoma; preparation; pupil dilatation