Unilateral mydriasis potentially associated with contact with a supplement powder mix

Dietary supplement use is common in military populations. Presented is a case of unilateral mydriasis from contact with a supplement mix. Standardized approach to mydriasis is fundamental for diagnosis.

A 20-year-old active duty Marine presented to the Emergency Department for evaluation of an enlarged pupil. She had no visual deficits or symptoms otherwise. She had been consuming increased amounts of energy drinks including a supplement powder mix and recalled rubbing her eye while pouring the mix that morning. Her exam demonstrated an asymmetric, nonreactive right pupil both directly and consensually with normal left pupil findings. Exam was otherwise unremarkable. Following unresponsiveness to pilocarpine challenges, pharmacological dilation was diagnosed potentially, secondary to supplement contact without absolute causative effect established. Two days afterward, her exam was normal.

Several supplement mixes contain compounds with stimulant activity mimicking medications used for pupil dilation. Unilateral mydriasis from contact with anticholingeric substances has been reported, specifically Angel's Trumpet, ipratropium, and moonflower, but there have been no reports with supplement mix-induced dilation.

Dietary supplement use in the military is an overwhelming phenomenon. This unique presentation of pharmacological mydriasis reinforces the importance of supplement histories in our military populations for various health presentations.