Acute Psychosis Induced by Topical Cyclopentolate Eye Drops in a Young Child

Abstract

Central anticholinergic syndrome (CAS) is a clinical entity whichshows central and peripheral effects produced by over dosage or abnormal reaction to clinical dosage of anticholinergic drugs. Anxiety, delirium, disorientation, hallucinations, seizures, tachycardia, hyperpyrexia, mydriasis, vasodilatation, gastric and urinary retention can be observed during CAS. Cyclopentolate is an anticholinergic drug, used in cycloplegic eye examinations for mydriasis. A 9 year old male child complaining of itching and redness in both eyes since 6 months visited to ophthalmology department. To examine eye proper single drop of Cyclopentolate eye drops was instilled to both eyes 3-4 times at an interval of 10 min. After 1 hour the child became restlessness, irritable and started talking irrelevantly. General and neurological examination did not reveal any abnormality. Psychiatrist's opinion revealed normal consciousness and orientation, muttering to self, delusion of persecution, visual hallucination and impaired judgment was noted. Based on the above findings, a rare adverse effect of drug-induced psychosis was suspected. The child was given single dose of Midazolam 2 mg IV in ICU to reduce behavioral abnormality and the child's behavior reverted to normal within 8 hours.