Topical Atropine Induced Acute Psychosis - A case report.

Area of Science:

• Ophthalmology
• Neuroscience
• Pharmacology

Background:

• Atropine is a common anticholinergic agent used topically in ophthalmology.
• Central anticholinergic syndrome is a potential adverse effect of atropine, typically associated with systemic administration.

Observation:

• An 82-year-old female, post-keratoplasty, experienced persistent eye pain.
• Topical atropine sulfate 1% eyedrops were administered thrice daily for pain management.
• The patient developed acute psychomotor agitation, disorientation, confusion, visual hallucinations, and reduced consciousness.

Findings:

• Symptoms resolved upon discontinuation of topical atropine and recurred upon re-administration.
• A psychiatric evaluation and rechallenge confirmed topical atropine as the cause of acute psychosis.
• Naranjo's algorithm indicated a definite adverse drug reaction.

Implications:

• Topical atropine can lead to central nervous system side effects through systemic absorption.
• Ophthalmologists should counsel patients on the potential for central anticholinergic syndrome with topical atropine use.
• Awareness of these CNS effects is crucial for safe routine ophthalmology practice.