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Delirium due to the use of topical cyclopentolate hydrochloride

Mahmut Atum1, Erkan Çelik1, Gürsoy Alagöz1

  • 1Sakarya University Education and Research Hospital, Department of Ophthalmology, Sakarya, Turkey.

Ideggyogyaszati Szemle
|February 15, 2020
PubMed

Insights

Cyclopentolate eye drops can rarely cause delirium in children. Physostigmine is an effective antidote for this rare, severe side effect, rapidly improving symptoms.

Area of Science:

  • Ophthalmology
  • Pediatric Neurology
  • Clinical Toxicology

Background:

  • Cyclopentolate is a commonly used anticholinergic mydriatic agent in ophthalmology.
  • Systemic side effects, though rare, can occur following ocular instillation.
  • Delirium is an uncommon but serious potential adverse reaction.

Observation:

  • A 7-year-old child developed acute delirium, including behavioral changes and visual hallucinations, post-cyclopentolate administration.
  • Symptoms manifested within 20-25 minutes after the final eye drop.
  • The child presented with gait disturbance and significant agitation.

Findings:

  • Cyclopentolate instillation can precipitate delirium as a rare systemic anticholinergic toxicity.
  • Physostigmine, an acetylcholinesterase inhibitor, was administered intravenously at 0.02 mg/kg.
  • Rapid and complete recovery was observed within minutes of physostigmine administration.

Implications:

  • Highlights the importance of recognizing delirium as a potential side effect of cyclopentolate in pediatric patients.
  • Establishes physostigmine as a crucial and effective antidote for managing severe agitation and delirium caused by cyclopentolate.
  • Suggests prompt physostigmine administration for rapid reversal of anticholinergic-induced delirium in pediatric cases.

Keywords:
deliriumphysostigmine antidotesystemic adverse effectstopical cyclopentolate

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