Dilated Fixed Pupils From Atropine

Frank J. Weinstock, MD
JAMA. 1974;229(3):267-268. doi:10.1001/jama.1974.03230410013007.
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To the Editor.—  The appearance of a patient with unilateral or bilateral fixed, dilated pupils is usually a matter of grave concern, making one consider angle closure glaucoma, cerebral aneurysm, brain tumor, subdural or subarachnoid hemorrhage, or other conditions. It always requires a careful, thorough evaluation.Several examples of less serious causes of such dilated pupils will be discussed.

  1. A 12-year-old boy is seen in the emergency room in a dazed condition due to a "sledding accident," with bilateral fixed, dilated pupils with some blurred vision but no papilledema. After repeated denials of medications or use of eye drops, urine positive for barbiturates induced him to admit to use of drugs from his "friends" and of atropine eye drops that his father had hidden after using them for an eye condition of the past.

  2. A 24-year-old woman complained of blurred vision, headache, and a unilateral dilated pupil. When


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