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Unilateral Dilated Pupil From Scopolamine Disk

John A. Carlston, MD
JAMA. 1982;248(1):31. doi:10.1001/jama.1982.03330010015015.
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To the Editor.—  We recently took a family trip to Mexico. While sitting on a bright, sunny terrace one morning at 11 AM, my 20-year-old daughter was accused of having a "funny eye" by her sister. On examination, her left pupil was completely dilated, in contrast to her small right pupil. The dilated pupil did not appear to react to light or accommodation; however, back in the hotel room, a bright light increased the thin rim of iris from perhaps 1.5 mm to 2 mm at most. There was no history of familial aneurysm, no head trauma, no nuchal rigidity, and no visual defect in that eye; in fact, I could ascertain nothing else abnormal. She had not used any eyedrops, and her only known medication was prophylactic doxycycline.A telephone call to her ophthalmologist in the United States elicited the routine question, "Any atropine drugs?" Then the light dawned.


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