Case of a fixed and dilated pupil: acute anisocoria secondary to aerosol ipratropium bromide
A 2-year-old boy was presented with acute anisocoria (figure 1). He had a history of DiGeorge syndrome, with right-sided perisylvian polymicrogyria, left-sided hemiplegia and seizure disorder. He was a known asthmatic, for which he was on ipratropium bromide through a spacer. His left pupil was maximally dilated and unreactive. Right pupillary reactions were normal. Acuity was 6/12 bilaterally with full extraocular movements, no evidence of ptosis and a normal fundus examination. A neurological examination was unremarkable. Given the complex neurological history and possible serious and time-sensitive cause, a CT of the head was performed. No new abnormality was identified. A diagnosis of iatrogenic anisocoria secondary to ipratropium was made, which has previously been reported in a handful of cases.1–3
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