Prolonged Unilateral Mydriasis after Nasal Septal Reconstruction

Gibson, Beth E.; Stanley, Robert J.; Lanier, William L.

doi:10.1213/00000539-198602000-00022

Cited by 7 publications

(9 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 reported postoperative unilateral mydriasis after nasal reconstruction surgery where topical cocaine and mucosal injections of lidocaine and epinephrine were used by the surgeons. The authors postulated that the retrograde passage of cocaine was most likely responsible for the mydriasis.…”

Section: Discussionmentioning

confidence: 99%

Unilateral mydriasis after nasal reconstruction surgery

D’Souza

Hadžić

Wider

2000

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To present a case of iatrogenic, unilateral pupillary dilatation after general anesthesia for nasal surgery. Unilateral pupillary dilatation after general anesthesia has sinister implications, which might prompt further investigations. However, in patients undergoing nasal surgery, it might be caused by the action of drugs injected intranasally. Consideration of iatrogenic causes of pupillary dilatation might help clinicians to avoid time-consuming and costly investigations.Clinical features: A 24-yr-old healthy woman underwent a general anesthetic for septoplasty and bilateral turbinectomy. She was hemodynamically stable and did not suffer any hypoxia intraoperatively. At the end of the operation her right pupil was dilated (8 mm diameter). Her left pupil was normal. No other abnormality was detected. After she woke up, her vision was grossly normal. Neurological examination did not show any other abnormality. Six to eight hours later, both pupils were equal (2 mm in diameter) and reacting normally to light and accommodation. Conclusion:The patient was a healthy 24-yr-old who underwent an operation in which there was no incident of hypoxia or hemodynamic instability. Since the patient recovered completely within six to eight hours, the pupillary dilatation was probably caused by epinephrine, which could have entered the eye through the nasolacrimal duct. Although pupillary dilatation after general anesthesia has been described, this is the first case report where the most likely causative agent was epinephrine, injected into the nasal submucosa.Objectif: Présenter un cas de dilatation pupillaire iatrogénique unilatérale survenue après l'anesthésie générale pour une intervention chirurgicale nasale. Cette situation présente de graves implications qui peuvent demander des investigations supplémentaires. Dans les cas d'une intervention nasale, la dilatation peut être causée par l'action du médicament injecté dans le nez. Un examen attentif de ses causes iatrogéniques peut éviter des recherches longues et coûteuses.Éléments cliniques : Une femme de 24 ans en bonne santé a subi une anesthésie générale pour une septoplastie et une turbinectomie bilatérale. L'hémodynamie était stable et la patiente n'a pas souffert d'hypoxie peropératoire. À la fin de l'intervention, sa pupille droite s'est dilatée (8 mm de diamètre). Sa pupille gauche était normale. Aucune autre anomalie n'a été détectée. Au réveil, la vision était sensiblement normale et l'examen neurologique n'a pas montré d'autre complication. Six à huit heures plus tard, les deux pupilles étaient égales (2 mm de diamètre) et réagissaient normalement à la lumière et à l'accommodation.Conclusion : Une patiente de 24 ans a subi une opération qui n'a pas présenté d'hypoxie ou d'instabilité hémo-dynamique. La dilatation pupillaire observée, avant une récupération complète qui a eu lieu de six à huit heures après l'opération, était probablement causée par l'épinéphrine qui a pu pénétrer dans l'oeil par le canal nasolacrimal. La dilatation pupillaire qui suit u...

show abstract

Section: Discussionmentioning

confidence: 99%

Unilateral mydriasis after nasal reconstruction surgery

D’Souza

Hadžić

Wider

2000

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…The exposure can be direct, as in phenylephrine drops splashing in the eye 36 or nebulized mydriatics bathing 1 eye only. 1 Retrograde passage of mydriatic medications through the nasolacrimal duct [37][38][39][40] and retrograde ciliary ganglion block 41 are other postulated mechanisms. Spread of local anesthetic with epinephrine through the pterygopalatine fossa and into the inferior orbital fissure, anesthetizing parasympathetic nerves and resulting in unilateral mydriasis, also has been described.…”

Section: Pharmacologic Causesmentioning

confidence: 99%

Unilateral Mydriasis After Maxillary Osteotomy: A Case Series and Review of the Literature

Brookes

Golden

Lawrence

et al. 2015

Journal of Oral and Maxillofacial Surgery

View full text Add to dashboard Cite

“…However, there is a number of cases published, where unilateral mydriasis was caused by drug application by either the anesthesiologist or the surgeon: topical nasal anesthesia using a phenylephrine/lidocaine spray, (1), nasal cocaine/epinephrine application (2,3) or other exposure to alphaadrenergic drugs (4,5). We present a case of a 2-year 9-month-old male infant, who was scheduled for adenotonsillectomy under general anesthesia with laryngeal mask airway (LMA).…”

mentioning

confidence: 99%

“…is a rare, recessively inherited neuropathy, characterized by diffuse impairment of discriminative touch and pressure sensation (1,2). Although autonomic dysfunction associated with HSAN 3 (Riley-Day syndrome or familial dysautonomia) are well known (3), nothing is known about autonomic dysfunction in patients with HSAN 2 (1,4). Although there is no previous report about autonomic nervous dysfunction, the association with distal anhydrosis has been described (3).…”

mentioning

confidence: 99%

“…S ir —Unilateral mydriasis unsettles the anesthesiologist as it might indicate a serious neurological complication with the necessity for rapid diagnostic interventions to differentiate possible life‐threatening disorders. However, there is a number of cases published, where unilateral mydriasis was caused by drug application by either the anesthesiologist or the surgeon: topical nasal anesthesia using a phenylephrine/lidocaine spray, (1), nasal cocaine/epinephrine application (2,3) or other exposure to alpha‐adrenergic drugs (4,5).…”

mentioning

confidence: 99%

See 1 more Smart Citation