Fentanyl
Reverse ocular dipping: case reportA 19-year-old male patient developed an abnormal eye movement known as reverse ocular dipping following treatment with fentanyl.The man had undergone a laminectomy for lumbar disc herniation. He received treatment with droperidol and fentanyl [dosage not stated] by continuous infusion for pain relief. The next day he reported involuntary upward movement in his eyes and his eyes exhibited conjugate upward movement that was followed by a brief tonic phase then rapid downward movement to the primary position. This cycle was repeated at irregular intervals. A brain CT and blood test showed no abnormalities.The man's treatment was withdrawn and his abnormal eye movements resolved within 2-3 hours.Author comment: "In our case, fentanyl may have induced reverse ocular dipping". Kitagawa N, et al. Drug-induced reverse ocular dipping. BMJ Case Reports