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Can ophthalmic drops cause central nervous system depression and cardiogenic shock in infants?

Kiril Kiryazov1, Mariyka Stefova, Violeta Iotova

  • 1From the Department of Pediatrics, University Multiprofile Hospital for Active Treatment "Sveta Marina," Varna, Bulgaria.

Pediatric Emergency Care
|November 8, 2013
PubMed

Insights

Topical glaucoma eye drops can cause severe systemic effects in infants, including central nervous system depression and cardiogenic shock. Careful evaluation of all topical medications is crucial for critically ill infants.

Area of Science:

  • Pediatric Intensive Care
  • Ophthalmology
  • Clinical Toxicology

Background:

  • Topical ocular medications are common for pediatric ophthalmic disorders.
  • Congenital glaucoma requires prompt treatment, often with topical antiglaucoma agents.

Observation:

  • Two infants in the pediatric intensive care unit presented with altered consciousness, hypotonia, hypothermia, bradycardia, and apnea after receiving topical antiglaucoma eye drops.
  • One infant also experienced hypotension and broncho-obstruction.

Findings:

  • Diagnosis of intoxication with topical antiglaucoma medications (brimonidine, brinzolamide, timolol) was established after excluding other causes.
  • Both infants recovered fully after discontinuing eye drops and receiving symptomatic treatment.

Implications:

  • Topically applied ophthalmic drops can lead to life-threatening systemic adverse effects in infants.
  • Clinicians must consider topical medications as potential causes of critical illness in infants.

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