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Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy

Yıl 2025, Cilt: 16 Sayı: 3, 102 - 104, 30.09.2025

Öz

Introduction
Unilateral fixed mydriasis is frequently associated with neurologic emergencies such as third cranial nerve palsy. However, rare toxicologic mimics—particularly those caused by topical exposure to anticholinergic alkaloids—may present similarly and lead to unnecessary neuroimaging. Datura arborea, an ornamental plant of the Solanaceae family, contains potent tropane alkaloids capable of inducing transient pharmacologic mydriasis via muscarinic receptor blockade.
Case Report
A 42-year-old previously healthy male developed sudden-onset blurred near vision and photophobia in the left eye shortly after accidental ocular contact with a flowering plant branch. Examination revealed left-sided dilated, nonreactive pupil with preserved extraocular movements, intact lid position, and impaired accommodation. Neurologic and fundoscopic examinations were unremarkable. A retrieved plant specimen was identified as Datura arborea by a consulting botanist. Pharmacologic testing with 1% pilocarpine produced no miosis, confirming muscarinic antagonism. The patient was managed conservatively with ocular irrigation, lubrication, and photoprotection. Symptoms resolved completely within 48 hours without recurrence.
Conclusion
Topical exposure to Datura arborea can produce unilateral pharmacologic mydriasis that closely mimics third nerve palsy. Early recognition, targeted exposure history, and bedside pupillary testing can guide appropriate management and help avoid unnecessary neurologic evaluation.

Kaynakça

  • 1. Clausen K, Davis S, Pourmand A.Approach to anisocoria in the emergency department. Am J Emerg Med. 2023 Jul:69:218. e1-218.e3. doi: 10.1016/j.ajem.2023.04.047.
  • 2. Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill; 2019.
  • 3. Felton TM, Greer J, Hendrickson RG. Pharmacologic mydriasis from topical plant exposure: a case report and review. Clin Toxicol (Phila). 2010;48(3):287–290.
  • 4. Waisbourd M, Kaiserman I. A curiouscase of gardener’s pupil: mydriasis after contact with Datura arborea. Clin Ophthalmol.2011;5:1453–1454.
  • 5. Wolff EA, Wray SH. Pharmacologic anisocoria. Surv Ophthalmol. 1983;27(5):287–290.
  • 6. YJ Yoo, MJ Hwang, KH Yang. Dilute pilocarpine test for diagnosis of Adie’s tonic pupil. Sci Rep. 2021 May 12;11:10089.
  • 7. Havelius U,Asman P. Accidental mydriasis from exposure to Angel’s trumpet (Datura suaveolens). Acta Ophthalmol Scand. 2002 Jun;80(3):332-5.
  • 8. Macchiaiolo M, Vignati E, Gonfiantini MV, Grandin A, Romano MT, Salata M, et al. An unusualcase of anisocoria by vegetal intoxication: a case report. Ital J Pediatr. 2010 Jul 20:36:50.
  • 9. Serin MH, Ozen B, Yilmaz S. A Rare Cause of Acute Anisocoria in a Child: The Angel’s Trumpet Plant. J Pediatr Ophthalmol Strabismus. 2018 Nov2:55:e33-e35.
  • 10. Subhash Joshi R. Corneal Toxicity due to Datura Inoxia. J Ophthalmic Vis Res. 2019;14(3):366-369. Published 2019 Jul 18. doi:10.18502/jovr.v14i3.4792

Datura arborea'dan kaynaklanan Antikolinerjik Göz Toksisitesi: Üçüncü Sinir Felcinin Geri Dönüşümlü Bir Taklidi

Yıl 2025, Cilt: 16 Sayı: 3, 102 - 104, 30.09.2025

Öz

Giriş
Tek taraflı sabit midriyazis sıklıkla üçüncü kranial sinir felci gibi nörolojik acil durumlarla ilişkilidir. Bununla birlikte, nadir toksikolojik durumlar (özellikle antikolinerjik alkaloidlere topikal maruziyetten kaynaklananlar) benzer şekilde ortaya çıkabilir ve gereksiz nörogörüntüleme yapılmasına yol açabilir. Solanaceae familyasından bir süs bitkisi olan Datura arborea, muskarinik reseptör blokajı yoluyla geçici farmakolojik midriyazis indükleyebilen güçlü tropan alkaloidleri içerir.
Vaka Sunumu
42 yaşında, daha önce sağlıklı olan bir erkek, çiçekli bir bitki dalıyla kazara göz temasından kısa bir süre sonra sol gözünde ani başlayan bulanık yakın görüş ve fotofobi geliştirdi. Muayenede sol tarafta genişlemiş, tepkisiz göz bebeği, korunmuş ekstraoküler hareketler, sağlam kapak pozisyonu ve bozulmuş akomodasyon ortaya çıktı. Nörolojik ve fundoskopik muayeneler dikkate değer değildi. Alınan bir bitki örneği, danışman bir botanikçi tarafından Datura arborea olarak tanımlandı. %1 pilokarpin ile yapılan farmakolojik testler miyozis üretmedi ve bu da muskarinik antagonizmayı doğruladı. Hastaya oküler irrigasyon, lubrikasyon ve fotokoruma ile konservatif tedavi uygulandı. Semptomlar 48 saat içinde tekrarlamadan tamamen düzeldi.
Sonuç
Datura arborea'ya topikal maruziyet, üçüncü sinir felcini yakından taklit eden tek taraflı farmakolojik midriyazise neden olabilir. Erken tanı, maruziyet öyküsü ve yatak başı pupil testi uygun yönetime yönlendirebilir ve gereksiz nörolojik değerlendirmeden kaçınmaya yardımcı olabilir.

Kaynakça

  • 1. Clausen K, Davis S, Pourmand A.Approach to anisocoria in the emergency department. Am J Emerg Med. 2023 Jul:69:218. e1-218.e3. doi: 10.1016/j.ajem.2023.04.047.
  • 2. Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR, Flomenbaum NE. Goldfrank’s Toxicologic Emergencies. 11th ed. New York: McGraw-Hill; 2019.
  • 3. Felton TM, Greer J, Hendrickson RG. Pharmacologic mydriasis from topical plant exposure: a case report and review. Clin Toxicol (Phila). 2010;48(3):287–290.
  • 4. Waisbourd M, Kaiserman I. A curiouscase of gardener’s pupil: mydriasis after contact with Datura arborea. Clin Ophthalmol.2011;5:1453–1454.
  • 5. Wolff EA, Wray SH. Pharmacologic anisocoria. Surv Ophthalmol. 1983;27(5):287–290.
  • 6. YJ Yoo, MJ Hwang, KH Yang. Dilute pilocarpine test for diagnosis of Adie’s tonic pupil. Sci Rep. 2021 May 12;11:10089.
  • 7. Havelius U,Asman P. Accidental mydriasis from exposure to Angel’s trumpet (Datura suaveolens). Acta Ophthalmol Scand. 2002 Jun;80(3):332-5.
  • 8. Macchiaiolo M, Vignati E, Gonfiantini MV, Grandin A, Romano MT, Salata M, et al. An unusualcase of anisocoria by vegetal intoxication: a case report. Ital J Pediatr. 2010 Jul 20:36:50.
  • 9. Serin MH, Ozen B, Yilmaz S. A Rare Cause of Acute Anisocoria in a Child: The Angel’s Trumpet Plant. J Pediatr Ophthalmol Strabismus. 2018 Nov2:55:e33-e35.
  • 10. Subhash Joshi R. Corneal Toxicity due to Datura Inoxia. J Ophthalmic Vis Res. 2019;14(3):366-369. Published 2019 Jul 18. doi:10.18502/jovr.v14i3.4792
Toplam 10 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Acil Tıp
Bölüm Case Report
Yazarlar

Gülçim Kocairi 0000-0003-3844-9180

Yalcin Golcuk 0000-0002-8530-8607

Tayyibe Büşra Türkmen 0009-0000-1010-1604

Yayımlanma Tarihi 30 Eylül 2025
Gönderilme Tarihi 14 Mayıs 2025
Kabul Tarihi 20 Haziran 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 16 Sayı: 3

Kaynak Göster

APA Kocairi, G., Golcuk, Y., & Türkmen, T. B. (2025). Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy. Journal of Emergency Medicine Case Reports, 16(3), 102-104. https://doi.org/10.33706/jemcr.1698743
AMA Kocairi G, Golcuk Y, Türkmen TB. Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy. Journal of Emergency Medicine Case Reports. Eylül 2025;16(3):102-104. doi:10.33706/jemcr.1698743
Chicago Kocairi, Gülçim, Yalcin Golcuk, ve Tayyibe Büşra Türkmen. “Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy”. Journal of Emergency Medicine Case Reports 16, sy. 3 (Eylül 2025): 102-4. https://doi.org/10.33706/jemcr.1698743.
EndNote Kocairi G, Golcuk Y, Türkmen TB (01 Eylül 2025) Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy. Journal of Emergency Medicine Case Reports 16 3 102–104.
IEEE G. Kocairi, Y. Golcuk, ve T. B. Türkmen, “Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy”, Journal of Emergency Medicine Case Reports, c. 16, sy. 3, ss. 102–104, 2025, doi: 10.33706/jemcr.1698743.
ISNAD Kocairi, Gülçim vd. “Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy”. Journal of Emergency Medicine Case Reports 16/3 (Eylül2025), 102-104. https://doi.org/10.33706/jemcr.1698743.
JAMA Kocairi G, Golcuk Y, Türkmen TB. Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy. Journal of Emergency Medicine Case Reports. 2025;16:102–104.
MLA Kocairi, Gülçim vd. “Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy”. Journal of Emergency Medicine Case Reports, c. 16, sy. 3, 2025, ss. 102-4, doi:10.33706/jemcr.1698743.
Vancouver Kocairi G, Golcuk Y, Türkmen TB. Ocular Anticholinergic Toxicity from Datura arborea: A Reversible Mimic of Third Nerve Palsy. Journal of Emergency Medicine Case Reports. 2025;16(3):102-4.