BMJ  2008;336:171 (26 January), doi:10.1136/bmj.39465.496204.3A

Letters

A fixed dilated pupil

Pilocarpine: better than a scan

The first 150 words of the full text of this article appear below.

Williams et al describe a patient with a fixed dilated pupil after using a prescription hand cream with antimuscarinic properties.¹

I was recently referred a 34 year old man admitted for investigation of an asymptomatic fixed dilated left pupil. The pupil abnormality was spotted by an observant staff nurse on the paediatric ward where he was visiting his daughter. He was sent to the accident and emergency department and later admitted for urgent investigations, which included computed tomography, magnetic resonance imaging and angiography of the head, and a battery of blood tests. When the results of all these investigations came back as normal, a neuro-ophthalmic opinion was sought.

My examination confirmed an unreactive mid-sized left pupil with no ptosis or ophthalmoplegia and no other neurological deficits. On closer questioning the patient explained that shortly before inserting his contact lenses that morning he had been manually crushing Vallergan tablets (an antihistamine . . . [Full text of this article]

¹ National Hospital for Neurology and Neurosurgery, London WC1N 3BG

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