Atropine
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Atropine Mydriasis and paralysis of accommodation following inappropriate drug used for diplopia: case report
A 46-year-old woman developed mydriasis and paralysis of accommodation following inappropriate use of atropine for diplopia. The woman self-referred and consulted for complaints of recent double vision, inability to read and fixed dilated pupils in June 2019. She stated she had received bilateral botulinum toxin A [botulinum A toxin] injections for cosmetic indication of mild radiating aging skin lines at the lateral canthus (crow’s feet). The spa-type clinic, where she was treated was physician-directed, but she was injected by a nurse. The physicians there were not ophthalmologists, ENT, dermatologists or plastic surgeons, specialties usually trained in these types of injections. Four to five days after the first set of injections, she noted double vision. The diplopia was worse at distance than at near; worse in lateral gaze. She had returned to the treating clinic. After informing them of her diplopia and having an examination, atropine eye drops [dosage not stated] were instilled in both eyes (instead of apraclonidine for treating diplopia). The purpose of the drops was not explained to her. Within an hour after receiving the drops she noted her pupils were nonreactive and large, and she was unable to read. At this point she made an urgent same day appointment with an ophthalmologist. Upon examination her corrected distance vision was 20/20 with glasses, but her near vision was 20/80 near equivalent. Abnormal findings included underaction of both lateral recti, no ptosis and nonreactive 5 millimeter pupils in both eyes. The rest of the eye examination was normal. During the exam, phone calls were made to the treating clinic. It was told from the clinic that a physician there had directed atropine eye drops to be instilled in both eyes after she had returned with complaints of diplopia. With this additional confirmatory history, diagnoses of botulinum toxin A injection (cosmetic) caused paresis of both lateral recti and subsequent iatrogenic mydriasis and paralysis of accommodation due to inappropriate atropine eye drop instillation were made. She was told that the double vision might take several months to clear. The dilated pupil and trouble reading might need weeks to over a month to wear off. She was given a time limited work excuse and warned about driving. She was told to return if her symptoms did not clear in the time outlined or other complications developed. The woman’s double vision and dilated pupil gradually cleared over the subsequent 2 months and she made a complete recovery. Hagan JC 3rd. Atropine Eye Drops Inappropriately Used for Diplopia Following Cosmetic Botulinum A Toxin Injections. [Review]. Missouri Medicine 117: 73-75, No. 1, 803519245 Jan-Feb 2020. Available from: URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023941/
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Reactions 5 Dec 2020 No. 1833
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