A case of accidental mydriasis

A 42-year-old man presented with a three-day history of progressive bilateral blurred vision, photophobia and headaches. There was no history of trauma. He was emmetropic with visual acuity of 6/60 (pinhole 6/24) in both eyes, no ptosis and full range of eye movements. His pupils were in fixed mydriasis. The pupils were unreactive to light or accommodation. His optic discs and fundi were normal. Pilocarpine failed to constrict his pupils. Initially, he strongly denied using any topical ocular medications but later remembered that 10 days previously his eyes had felt 'gritty' and his wife had instilled their son's old atropine penalisation drops into both his eyes. His signs and symptoms had resolved over the next two days.