![]() The chemical structure of scopolamine is known to be very similar to that of atropine, and when instilled into the eye, it induces a mydriasis and causes sedation, antiemesis, and memory impairment In particular, scopolamine is the first commercialized transdermal absorption treatment is applied to the skin behind the ear, which is relatively easily absorbed and is marketed for the prevention of motion sickness and nausea and vomiting after surgery. It was confirmed that improvement naturally occurs over time.Ī substance called scopolamine or hyoscine is a parasympathetic inhibitor that competitively inhibits the muscarinic acetylcholine receptor. We report the exclusion of important diseases using pilocarpine and apraclonidine hydrochloride. Lessons:Ī detailed history of the use of medications such as scopolamine patches in patients with unilateral dilated pupils without vision loss is of utmost importance. The pupil size in the right eye gradually decreased to 4.5 mm on the second day of observation and to 3.6 mm on the fourth day of observation. Interventions:Īrtificial tears were administered and the patient was observed and monitored. Moreover, upon further investigation, we discovered that the patient had a scopolamine transdermal patch applied for 2 days prior to the clinic visit. We then applied 0.125% and 1% pilocarpine to exclude oculomotor nerve palsy however, it could not be ruled out as constriction of pupil to 3.1 mm in the right eye was observed after applying 1% pilocarpine. Furthermore, as we did not observe dilatation lag in the smaller pupil, we applied 1% apraclonidine in the left eye in order to rule out Horner syndrome and did not observe dilatation of the pupil. The patient neither did present with facial anhidrosis nor did she present with ptosis. ![]() The pupil size was 5.0 mm in the right eye and 2.0 mm in the left eye, and the extraocular muscles of both eyes were intact. The anterior chambers in both eyes were unremarkable on slit-lamp examination. Corrected visual acuities was 20/20 in both eyes, and the intraocular pressures were 20 and 18 mm Hg in the right and left eye, respectively. Patient concerns:Ī 35-year-old woman with no past ophthalmologic history presented to the ophthalmology department complaining of a dilated pupil in the right eye. We report a case of anisocoria that occurred after contamination with a scopolamine transdermal patch, and introduce a diagnostic approach for anisocoria patients. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The authors have no conflicts of interest to disclose.ĭata sharing not applicable to this article as no datasets were generated or analyzed during the current study. This research was supported by the National Research Foundation of Korea (NRF), funded by the Ministry of Science and ICT (2018M3A9E8078812). Anisocoria after scopolamine transdermal patch contamination: a case report. ∗Correspondence: Jin-Ho Joo, Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, # 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea (e-mail: ).Ībbreviations: ANS = autonomic nervous system, MRI = magnetic resonance imaging, MRA = magnetic resonance angiography. Referral to primary care doctor for evaluation and treatment of migraines and/or high blood pressure once eye health normal status confirmed.Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Seoul, Korea. DiagnosisĪn eye exam by a doctor of optometry is necessary to rule out other causes of flashing light in vision, such as a retinal tear or detachment, or damage inside the eye. If the headache is so severe that the pupils (the dark spots in the center of your eye) are not equal in size or are very dilated or very constricted and there is severe nausea and vomiting, this could be a sign of a serious even life-threatening condition that requires immediate emergency medical intervention. Sparkling (Scintillating) lights and/or darkness of vision, generally starting in the middle and expanding to the outside followed by a severe headache. Similar to migraine, causes include stress, alcohol consumption (especially red wine), hormonal triggers in women, poor diet or lack of sleep, family history, allergic responses or environmental factors such as allergy or bright or flashing lights.
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