Downloaded from http://adc.bmj.com/ on July 6, 2015 - Published by group.bmj.com
Original article
IMAGES IN PAEDIATRICS
Unequal pupils following removal of hyoscine patch A 14-year-old boy on maintenance treatment for acute lymphoblastic leukaemia presented with blurred vision and dilatation of the left pupil. There was no history of headache or features of raised intracranial pressure. Visual acuity was normal in both eyes (6/6 unaided). The left pupil did not constrict to direct light or to a near target. The left consensual light response was normal (indicating no relative afferent pupillary defect). Neurological examination and fundoscopy were normal. The patient had removed a hyoscine patch placed behind the left ear earlier that day (applied to prevent chemotherapy-related nausea). The mydriasis resulted from touching the eye after this. Patients should be encouraged to wash the application site and hands after removing or touching a hysocine patch. Note the detailed history taking avoided unnecessary imaging (figure 1).
Figure 1
Picture showing unequal pupils.
Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
N Pieris, A D Baldwin, P DeSilva, M Wong
To cite Pieris N, Baldwin AD, DeSilva P, et al. Arch Dis Child 2014;99:196.
Paediatric department, Eastbourne District General Hospital, Eastbourne, UK
Accepted 5 October 2013 Published Online First 22 October 2013
Correspondence to Dr P DeSilva, Paediatric department, Eastbourne District General Hospital, Eastbourne BN21 2UD, UK; [email protected]
196
Arch Dis Child 2014;99:196. doi:10.1136/archdischild-2013-305126
Allen L, et al. Arch Dis Child 2014;99:193–196. doi:10.1136/archdischild-2013-305085
Downloaded from http://adc.bmj.com/ on July 6, 2015 - Published by group.bmj.com
Unequal pupils following removal of hyoscine patch N Pieris, A D Baldwin, P DeSilva and M Wong Arch Dis Child 2014 99: 196 originally published online October 22, 2013
doi: 10.1136/archdischild-2013-305126 Updated information and services can be found at: http://adc.bmj.com/content/99/3/196
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Articles on similar topics can be found in the following collections Eye Diseases (158) Competing interests (ethics) (157) Headache (including migraine) (120) Journalology (209) Oncology (713) Pain (neurology) (544)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Original article
IMAGES IN PAEDIATRICS
Unequal pupils following removal of hyoscine patch A 14-year-old boy on maintenance treatment for acute lymphoblastic leukaemia presented with blurred vision and dilatation of the left pupil. There was no history of headache or features of raised intracranial pressure. Visual acuity was normal in both eyes (6/6 unaided). The left pupil did not constrict to direct light or to a near target. The left consensual light response was normal (indicating no relative afferent pupillary defect). Neurological examination and fundoscopy were normal. The patient had removed a hyoscine patch placed behind the left ear earlier that day (applied to prevent chemotherapy-related nausea). The mydriasis resulted from touching the eye after this. Patients should be encouraged to wash the application site and hands after removing or touching a hysocine patch. Note the detailed history taking avoided unnecessary imaging (figure 1).
Figure 1
Picture showing unequal pupils.
Competing interests None. Patient consent Obtained. Provenance and peer review Not commissioned; internally peer reviewed.
N Pieris, A D Baldwin, P DeSilva, M Wong
To cite Pieris N, Baldwin AD, DeSilva P, et al. Arch Dis Child 2014;99:196.
Paediatric department, Eastbourne District General Hospital, Eastbourne, UK
Accepted 5 October 2013 Published Online First 22 October 2013
Correspondence to Dr P DeSilva, Paediatric department, Eastbourne District General Hospital, Eastbourne BN21 2UD, UK; [email protected]
196
Arch Dis Child 2014;99:196. doi:10.1136/archdischild-2013-305126
Allen L, et al. Arch Dis Child 2014;99:193–196. doi:10.1136/archdischild-2013-305085
Downloaded from http://adc.bmj.com/ on July 6, 2015 - Published by group.bmj.com
Unequal pupils following removal of hyoscine patch N Pieris, A D Baldwin, P DeSilva and M Wong Arch Dis Child 2014 99: 196 originally published online October 22, 2013
doi: 10.1136/archdischild-2013-305126 Updated information and services can be found at: http://adc.bmj.com/content/99/3/196
These include:
Email alerting service
Topic Collections
Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Articles on similar topics can be found in the following collections Eye Diseases (158) Competing interests (ethics) (157) Headache (including migraine) (120) Journalology (209) Oncology (713) Pain (neurology) (544)
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
