4/27/2023 0 Comments Unequal pupil size lamictalPupil diameters, measured to the nearest 0.5 mm using a hand-held ophthalmic pupillometer, were recorded by an investigator blinded to the subject's history, etiology of unilateral mydriasis, and treatment group. Also excluded were patients with acute unilateral mydriasis of unknown etiology. Patients with hemodynamic instability, known ophthalmic disease, and use of anticholinergic or muscle relaxant medications were excluded from the study. Subjects studied included those with acute neurogenic mydriasis of known etiology and controls with baseline equal pupil diameters. To minimize observer bias, all subjects were patients in the neurologic intensive care unit and efforts were made to match subject groups by age, ASA class, and mode of ventilation (spontaneous versus mechanical). MethodsĪfter Human Investigation Committee approval and written, informed consent, 21 ASA class III and IV patients were studied. The purpose of this study was to determine whether the administration of low concentration ophthalmic pilocarpine would provide rapid differentiation of central neurogenic from phenylephrine-induced mydriasis. Unilateral mydriasis has resulted from unintentional eye exposure to phenylephrine used for nasal mucosal vasoconstriction. This may require a cranial computed tomography scan, which is costly and time consuming and requires the transfer of a newly postoperative patient to radiology. Although anisocoria may result from numerous causes after general anesthesia, it is imperative to rapidly diagnose life-threatening intracranial hypertension. A new postoperative finding of anisocoria, i.e., markedly unequal pupil size, may indicate serious neurologic injury.
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