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Updated: Oct 12, 2025
Impression Cytology of the Lid Wiper Area
Published on: August 9, 2016
Anisocoria secondary to antiperspirant wipes in a pediatric population: a case series
Joseph D Pecha1, Kimberly G Yen2, Alexis Moisiuc3
1Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
Insights
Accidental exposure to glycopyrronium wipes can cause acute mydriasis (dilated pupil) in children. Symptoms like blurry vision and headache resolved without intervention, highlighting the importance of considering topical anticholinergic exposure.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Clinical Toxicology
Background:
- Acute anisocoria and mydriasis in children have diverse causes, including serious neurological conditions.
- Topical anticholinergic agents, such as glycopyrronium, are used for conditions like hyperhidrosis.
- Misidentification of the cause can lead to unnecessary investigations and delayed diagnosis.
Purpose of the Study:
- To report the first case series of pediatric patients experiencing acute mydriasis from accidental exposure to glycopyrronium wipes.
- To raise awareness among healthcare providers about this potential adverse effect of glycopyrronium wipes in children.
- To emphasize the importance of a thorough patient history, including environmental exposures, in diagnosing pediatric mydriasis.
Main Methods:
- Retrospective case series analysis of six pediatric patients (ages 12-16) presenting with acute mydriasis.
- Review of clinical presentations, diagnostic workups, and treatment outcomes.
- Identification of exposure to glycopyrronium wipes as the causative agent.
Main Results:
- Six pediatric cases of acute mydriasis linked to glycopyrronium wipe exposure were identified.
- Associated symptoms included blurry vision and unilateral headache.
- Initial presentations varied, with some requiring emergent care and consultations with ophthalmology or neurology.
- In three cases, glycopyrronium wipe use was not initially reported, leading to neuroimaging.
- All symptoms resolved spontaneously without specific treatment.
Conclusions:
- Topical glycopyrronium wipe exposure is a potential cause of acute mydriasis in pediatric patients.
- A detailed history, including recent product use, is crucial for accurate diagnosis.
- Prompt recognition can prevent unnecessary diagnostic procedures and ensure appropriate patient management.
Abstract:
Acute-onset anisocoria or mydriasis in children carries a broad differential diagnosis and includes both benign and life-threatening causes, ranging from systemic or topical drug use to peripheral or central nervous system disease. The topical anticholinergic agent glycopyrronium (approved by the Food and Drug Administration in June 2018) is used to treat hyperhidrosis. We present the first case series of pediatric patients presenting with acute mydriasis due to exposure to glycopyrronium wipes. Six cases (ages 12-16) were identified: 3 presented emergently and 3 to a primary care physician. Additional symptoms included blurry vision (4/6) and unilateral headache (1/6). In 3 cases, use of glycopyrronium wipes was not elicited initially, neuroimaging was obtained, and ophthalmology (2/3) or neurology (1/3) was consulted. One patient remained undiagnosed and presented emergently again 2 months later. In all patients, symptoms resolved without further treatment.
