Anticholinergic syndrome: blurred vision and headache
Lisa McAnena1, Gordon T Plant2, Sui Hsien Wong3
1Department of Neuro-ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Practical Neurology
|February 22, 2023
Summary
Anticholinergic syndrome can cause blurred vision, especially with multiple medications. Recognizing this and the rare reverse Argyll Robertson pupil is crucial for diagnosis.
Area of Science:
- Ophthalmology
- Clinical Pharmacology
Background:
- Anticholinergic syndrome is a potential adverse drug reaction, particularly in patients with polypharmacy.
- Blurred vision is a common symptom, but specific pupil abnormalities warrant further investigation.
Approach:
- Case report of a young woman with anticholinergic syndrome and blurred vision.
- Review of the literature on anticholinergic syndrome and reverse Argyll Robertson pupil.
- Analysis of the potential mechanism of the observed pupil abnormality.
Key Points:
- The case highlights the importance of assessing anticholinergic burden from multiple medications.
- The reverse Argyll Robertson pupil (preserved light reflex, absent accommodation) is a key finding.
- Differential diagnosis for this pupil abnormality includes various neurological and toxicological conditions.
Conclusions:
- Clinicians should consider anticholinergic syndrome in patients presenting with blurred vision and polypharmacy.
- The reverse Argyll Robertson pupil, though rare, can be a sign of anticholinergic toxicity.
- Further research into the mechanisms and diagnostic markers of anticholinergic-induced pupil abnormalities is needed.
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