"Don't Believe Your Eyes" Ipratropium Induced Mydriasis: A Case Report and Review of the Literature.
Unilateral fixed mydriasis can be an ominous sign; however in many cases, it is benign and represents pharmacologic mediated action on the iris dilator or sphincter. Differentiation between pharmacologic mediated anisocoria and physiologic anisocoria can be challenging but may save on costly imaging. An 83 year-old woman was admitted with critical limb ischemia and subsequently developed respiratory failure treated with positive pressure ventilation and ipratropium nebulizers. She was noted to have left unilateral mydriasis without other neurologic deficits. Brain magnetic resonance imaging with MR angiography showed no evidence for a mass lesion or posterior communicating artery aneurysm. Her anisocoria self-resolved within 36 hours after nebulizer treatments were stopped. Ipratropium bromide is one of the most common medications used in the hospital setting and should be consider as a possible etiology when examining patients with unilateral mydriasis in the absence of other neurologic findings.
Department of Internal Medicine, Mayo Clinic, Rochester, USA.
Kelly M
KM
Pennington
Department of Neurology, Mayo Clinic, Rochester, USA.
Erik K
EK
St Louis
Anisocoria; Iatrogenic; Ipratropium; Mydriasis; Pharmacology
Ir Med J. 2010 May;103(5):156-7
20669389
Eur J Anaesthesiol. 2008 Aug;25(8):692-3
18339219
N Engl J Med. 2006 Mar 2;354(9):e8
16510741
Saudi Med J. 2014 May;35(5):508-9
24825815
Am J Emerg Med. 2011 Jun;29(5):576.e5-6
20708871
Indian J Crit Care Med. 2014 Mar;18(3):176-7
24701070
J Neuroophthalmol. 2008 Sep;28(3):236-7
18769293
J Emerg Trauma Shock. 2012 Apr;5(2):199-200
22787356
Neurology. 2006 Sep 12;67(5):914
16966571
Anaesth Intensive Care. 2009 Sep;37(5):861-2
19775060
Am Rev Respir Dis. 1986 Oct;134(4):844
2945505
Ann Intern Med. 1998 Feb 15;128(4):327
9471951
J Clin Neurosci. 2008 Mar;15(3):320-1
18191575
Respir Care. 2005 Dec;50(12):1662-4
16318649
Crit Care Resusc. 2004 Dec;6(4):268-70
16556105