Author(s): Abdulla Alfraija*, MD, Mohamed Alseadawyb, MD, Walid Hasanb, MD
aPediatric intensive care unit, Pediatrics Division, General Ahmadi Hospital, Kuwait Oil Company (KOC), Al Ahmadi Area, Kuwait.
bPediatric intensive care unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al Nasser Area, Kuwait.
Citation: Alfraij A, Alseadawy M, Hasan W (2024) Unilateral Fixed Dilated Pupil in A Child with Critical Asthma: When A Nebulized Therapy Causes A Worrisome Sign and Rare Side Effect. Anna Clin Rev Cas Rep: ACRCR-129
Abstract
Background: New onset anisocoria is a scary sign that may often suggest a life-threatening condition. Reservable causes of anisocoria include medication and herbal exposure. Eye contamination with ipratropium bromide mist may cause anisocoria by inducing unilateral mydriasis.
Methods: We are reporting a case of critical asthma triggered by a viral illness treated with an intensive nebulization regimen inside the pediatric intensive care unit. The child developed a new onset of unilateral fixed dilated pupil despite a normal neurological examination.
Results: The anisocoria resolved within a day after stopping ipratropium bromide, and pupils returned to normal without any sequala. Life-threatening causes in the brain were ruled out using a CT scan.
Conclusion: Despite the fact that ipratropium bromide nebulization is a standard therapy used in asthma cases, but anisocoria is a rare side effect that could be underreported due to its benign nature. Increasing awareness of this side effect and ensuring the appropriate seal of the nebulization mask can help reduce unnecessary investigation.
Keywords: Unequal pupils, Anisocoria, ipratropium bromide, PICU, Pediatrics.