Ataxia by cycloplegic

Agustín Arévalo VelascoRosa M. Herrero Antón

Emergency department. Hospital Universitario de Salamanca.

Introduction

Cyclopentolate is commonly used as a mydriatic and cycloplegic. The occurrence of side effects of its anticholinergic action at appropriate doses is unlikely. Confusional states have been reported with abnormal behavior, visual and auditory hallucinations and cerebellar as typical clinical manifestations of toxic doses. We present the case of a patient who developed ataxia after exposure to a cycloplegic eye drops, the literature is reviewed.

Case presentation 73 year old woman who complains of loss of strength in lower extremities. Arrives by ambulance after being treated in the street with suspected stroke. The patient reported that going to take the bus crashes, legs fail him and feels he can not walk. It has no other symptoms: no chest pain, no headache, no dizziness, no loss of consciousness, speech correction, no difficulty moving the upper extremities.

As background is hypertensive, dyslipidemic, no drug allergies and usually takes diltiazem. On examination we found a patient was awake and oriented, eupneic, mydriatic pupils with normal cardiopulmonary auscultation, normal, abdomen, extremities without edema, strength and sensitivity preserved tendon reflexes osteo-normal, bilateral plantar flexor. Ataxic, unable to walk. Routine tests are normal. Asked, the patient tells us that in the hours before the review has been to your ophthalmologist and had been cyclopentolate instilled in both eyes.

We decided to adopt an expectant attitude and after four hours, the patient may be standing alone. Given the apparent improvement propose to follow the patient observation in the hospital, but given its convenient location the patient decides outpatient control. Contacted the patient at 36 hours, and do your usual tasks and symptoms have disappeared “ 'm not as drunk.”

CommentApproximately 10% of patients treated with topical anticholinergic side effects may occur. Most dizziness, ataxia and delirium. Topical absorption is also nasal and oral. Typically, we administer more doses by the possibility of loss of substance and therefore continue instilling the drug reaching toxic doses.

Bibliography Efecto neurotóxico inducido por administración

tópica de cicloplejico. Presentación de un caso y revisión de literatura. Jiménez FJ, Alonso H, Fernández A, Adeva MT, Ruiz JJ, Martín M.

Rev Neurol. 2006 Nov 16-30;43(10):603-9.

Acute phychotic reaction caused by topical ciclopentolate use for cycloplegic refraction before refractive surgery: case report.Mirshahi A, Kohnen T.

J Cataract Refract Surg. 2003 May;29(5):1026-30.