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Unilateral mydriasis caused by transdermal scopolamine.
M M Rubin1, R S Sadoff, G M Cozzi
1Nassau County Medical Center, East Meadow, N.Y.
Oral Surgery, Oral Medicine, and Oral Pathology
|November 1, 1990
Summary
Accidental eye contamination from transdermal scopolamine patches can cause mydriasis (pupil dilation). A simple office test helps identify this pharmacologic effect, preventing unnecessary neurologic evaluations.
Area of Science:
- Ophthalmology
- Pharmacology
- Neurology
Background:
- Transdermal scopolamine patches are used for motion sickness and postoperative nausea.
- Accidental ocular exposure can occur during patch handling.
- Ocular exposure may lead to pharmacologic mydriasis, mimicking neurological conditions.
Observation:
- Patients may present with unilateral or bilateral pupil dilation after handling scopolamine patches.
- This mydriasis is a direct effect of scopolamine on the eye's iris sphincter muscle.
- The condition is often transient but can cause significant patient and physician concern.
Findings:
- A simple office-based test can differentiate pharmacologic mydriasis from other causes.
- The test involves assessing pupillary response to a weak miotic agent, like 0.1% pilocarpine.
- Pharmacologic mydriasis due to scopolamine will not respond to pilocarpine.
Implications:
- This diagnostic approach can prevent extensive and costly neurologic workups for a benign condition.
- Early identification avoids misdiagnosis and unnecessary patient anxiety.
- Educating patients on proper patch handling is crucial to prevent accidental exposure.