CASE-REPORT ON A BILATERAL, SPONTANEOUSLY REVERSIBLE, NONREACTIVE MYDRIASIS

A 43-year old female patient was admitted to our Neurological Outpatie nt Clinic from the University Eye Clinic for further evaluation of a b ilateral mydriasis. The symptoms had started one day earlier with sens itivity to sunlight and difficulties in reading. Examinations in the E ye Clinic showed no signs of eye involvement. Neither the neurological examination nor the described symptoms showed any signs of dorsal mid brain or peripheral nerve involvement. The application of eyedrops con taining a 1% solution of pilocarpin did not lead to any pupil reaction after 30 min, so that a toxic parasympathicolytic reaction had to be assumed. No further diagnostic or therapeutic steps were taken. After the second visit 8 days later only a discrete anisocoria with mydriasi s on the left eye could be observed. Retrospectively, we must assume t hat on her daily walks through the forest the patient came into contac t with a plant containing atropine or scopolamine and that this antich olinergic substance had accidentally got into both eyes.