[Iatrogenic anisocoria after using a scopolamine patch for PONV prophylaxis]

Area of Science:

• Anesthesiology
• Ophthalmology
• Pharmacology

Background:

• Scopolamine patches are commonly used for preventing postoperative nausea and vomiting (PONV).
• While effective, scopolamine can have side effects, including ophthalmological complications.
• This case report details an instance of unilateral mydriasis following scopolamine patch application.

Observation:

• A 29-year-old female developed unilateral mydriasis (anisocoria) in the left eye after receiving a scopolamine patch for PONV prevention.
• Neurological, ophthalmological, and MRI investigations were conducted but revealed no underlying pathology.
• The anisocoria resolved spontaneously within 24 hours without intervention.

Findings:

• The unilateral mydriasis was suspected to be a pharmacologically induced side effect of the scopolamine patch.
• Accidental contact of the scopolamine substance with the affected eye is the presumed mechanism.
• Dysfunctional accommodation is a known, common side effect of scopolamine, affecting over 10% of patients.

Implications:

• Clinicians should be aware of the potential for ophthalmological side effects like anisocoria when prescribing scopolamine patches.
• The application of scopolamine patches warrants careful consideration, especially in surgical fields where anisocoria might mimic other complications.
• This case highlights the importance of considering medication side effects in differential diagnoses.