Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
Department of Ophthalmology, Baylor College of Medicine, Houston, Texas; Department of Surgery, Texas Children's Hospital, Houston, Texas.
J AAPOS. 2022 Feb;26(1):42-43. doi: 10.1016/j.jaapos.2021.08.301. Epub 2021 Nov 17.
Acute-onset anisocoria or mydriasis in children carries a broad differential diagnosis and includes both benign and life-threatening causes, ranging from systemic or topical drug use to peripheral or central nervous system disease. The topical anticholinergic agent glycopyrronium (approved by the Food and Drug Administration in June 2018) is used to treat hyperhidrosis. We present the first case series of pediatric patients presenting with acute mydriasis due to exposure to glycopyrronium wipes. Six cases (ages 12-16) were identified: 3 presented emergently and 3 to a primary care physician. Additional symptoms included blurry vision (4/6) and unilateral headache (1/6). In 3 cases, use of glycopyrronium wipes was not elicited initially, neuroimaging was obtained, and ophthalmology (2/3) or neurology (1/3) was consulted. One patient remained undiagnosed and presented emergently again 2 months later. In all patients, symptoms resolved without further treatment.
儿童急性瞳孔不等大或散瞳的鉴别诊断范围很广，包括良性和危及生命的原因，从全身或局部药物使用到周围或中枢神经系统疾病。局部抗胆碱能药物格隆溴铵（2018 年 6 月获得美国食品和药物管理局批准）用于治疗多汗症。我们报告了首例因接触格隆溴铵湿巾而导致急性散瞳的儿科患者病例系列。共发现 6 例（年龄 12-16 岁）：3 例紧急就诊，3 例就诊于初级保健医生。其他症状包括视力模糊（4/6）和单侧头痛（1/6）。在 3 例中，最初未引出格隆溴铵湿巾的使用情况，获得了神经影像学检查结果，并咨询了眼科（2/3）或神经内科（1/3）。1 例患者仍未明确诊断，2 个月后再次紧急就诊。所有患者的症状均无需进一步治疗而缓解。
