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Unilateral mydriasis after nasal reconstruction surgery
M G D'Souza1, A Hadzic, T Wider
1Department of Anesthesiology, St. Luke's/Roosevelt Hospital Center, New York, NY 10025, USA. mgd11@columbia.edu
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|November 30, 2000
Summary
A case of unilateral pupillary dilatation after nasal surgery was likely caused by intranasal epinephrine. This iatrogenic effect resolved within hours, highlighting the importance of considering drug actions during general anesthesia.
Area of Science:
- Anesthesiology
- Ophthalmology
- Otorhinolaryngology
Background:
- Unilateral pupillary dilatation after general anesthesia can suggest serious neurological events.
- Nasal surgery involves intranasal drug administration, posing a potential iatrogenic cause for pupillary changes.
Observation:
- A 24-year-old woman developed isolated right-sided pupillary dilatation post-septoplasty and turbinectomy under general anesthesia.
- The patient was hemodynamically stable and normoxic; neurological examination was otherwise normal.
- Pupillary abnormality resolved spontaneously within 6-8 hours.
Findings:
- The most probable cause of the unilateral mydriasis was epinephrine infiltration into the nasal submucosa.
- Epinephrine likely entered the eye via the nasolacrimal duct, causing temporary pupillary dilatation.
Implications:
- Clinicians should consider iatrogenic causes, such as intranasal drug effects, for unilateral pupillary dilatation after nasal surgery.
- Recognizing this benign cause can prevent unnecessary and costly investigations for sinister neurological conditions.
- This case highlights the importance of considering drug delivery routes in anesthetic complications.