Wednesday, October 2, 2019

Pharmacologic mydriasis

Q: Pharmacologic mydriasis is very common in ICU. How it can be confirmed?

AnswerMany drugs in ICU can cause mydriasis such as atropine, phenylephrine, clonidine, scopolamine patch, and aerosolized ipratropium. 

Pharmacologic mydriasis can be confirmed by demonstrating partial or no constriction by application of a 1% pilocarpine eye drop. In all other causes of the dilated pupil (except direct damage to pupillary sphincter from trauma or surgery), 1% pilocarpine will cause maximal pupillary constriction.




 Iosson N. Images in clinical medicine. Nebulizer-associated anisocoria. N Engl J Med 2006; 354:e8. 

CARTER JH: Diagnosis of pupillary anomalies. J. Am. Optom. Assoc. (1979) 50(6):671–680.

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