Pharmacological Dilated Pupil

Summary I. Pharmacologic dilation of the pupils a. Defined as a large pupil dilated on the order of 10 or 11 millimeters. b. If the other eye is uninvolved, the condition is normal. II. When light is shone on the pharmacologically dilated pupil, the pupil won't do anything a. If the light is shone on the normal pupil, there will be constriction. III. Test the near reaction of the pupils. a. If the pupil is pharmacologically blocked, it won't react to either the near test or to light, it will just stay dilated. IV. Make sure it's not a third nerve palsy. a. If there's no ptosis and no motility deficit, it is not a third nerve palsy. V. Test this dilated pupil with pilocarpine. a. If it is an Adie's tonic pupil, use one quarter percent pilocarpine or 1/10 percent pilocarpine. i. If the pilocarpine low dose is negative, then use the full-strength pilocarpine of 1%. ii. If at both pilocarpine 1/10 percent and pilocarpine 1% failed to constrict his pupil, that is evidence that this pupil is pharmacologically blocked. VI. Other agents that cause pupil dilation in isolation a. Atropine agents b. Nurses: after administering inhalers c. Post-surgery patients and cruise participants: scopolamine patches d. Accidental exposures. VII. Summary: a. A pharmacologically dilated pupil is big and does not respond to light/ near test b. Rule out a third nerve palsy by identifying lack of ptosis and no movement deficit. c. Rule out Adie's tonic pupil in the acute phase by doing a 1/10 percent pilocarpine followed by a full-strength pilocarpine 1%. i. If it doesn't constrict to anything, be assured that this is a pharmacologically dilated pupil. d. Ask the patient about scopolamine use, atropine use, or inadvertent exposure e. Two things that could dilate the pupil in the garden: belladonna alkaloids and Jimsonweed f. Reassure patients that the condition will resolve over time.