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Bilateral Mydriasis in a Post-parotidectomy Patient: A Case Report
Ahmad Daneshi1, Saleh Mohebbi1, Milad Shemshadi1
1Head & Neck Research Department, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran.
Archives of Iranian Medicine
|August 2, 2025
Summary
Anticholinergic medications used in anesthesia can cause pupil dilation and eyelid drooping, mimicking neurological issues. This case highlights the importance of considering medication side effects during postoperative assessments, especially after head and neck surgery.
Area of Science:
- Anesthesiology
- Ophthalmology
- Neurology
Background:
- Anticholinergic agents like atropine and glycopyrrolate are standard in anesthesia for reducing secretions and vagal tone.
- High doses can cause mydriasis (pupil dilation), complicating neurological assessments, particularly in head and neck procedures.
- Limited research addresses these specific anticholinergic effects in surgical contexts.
Purpose of the Study:
- To report a case of bilateral unresponsive mydriasis and ptosis following anesthesia.
- To emphasize the potential for anticholinergic side effects to mimic neurological pathology postoperatively.
- To highlight the need for clinical awareness of these iatrogenic effects.
Main Methods:
- A case report of a 35-year-old female undergoing left superficial parotidectomy.
- Preoperative assessment of normal ocular and neurological function.
- Postoperative observation of bilateral ptosis and unresponsive mydriasis.
Main Results:
- The patient developed bilateral ptosis and unresponsive mydriasis after surgery.
- These pupillary and eyelid changes were attributed to intraoperative anticholinergic administration.
- The findings mimicked neurological deficits, posing a diagnostic challenge.
Conclusions:
- Anticholinergic agents can induce pupillary and eyelid abnormalities that resemble neurological conditions.
- Clinicians must maintain a high index of suspicion for medication side effects in postoperative evaluations.
- Awareness and meticulous assessment are crucial to differentiate iatrogenic effects from true neurological pathology.
