Acute Delirium in an Adult After Topically Cyclopentolate Use

Abstract

Cyclopentolate eye drop is mostly preferred as a cycloplegic drug before the refractive and fundus examination in ophthalmology clinics. Few adverse effects were reported in relation with cyclopentolate 1% in adults. Before the fundus examination was performed to a 82 year old man, 1 drop of cyclopentolate 1% was installed in each eye and repeated for 3 times. 30 minutes later, ıt was seen that the patient has gait ataxia, fatigue and incoherent speech findings. The patient was in euphoric mood and had an impaired perception of time and place. His neurologic examination revealed no other pathologic findings. He fully recovered 5 hours after the onset of symptoms. At the control visit, retrograde amnesia was reported. Before the installation of the cyclopentolate, which may exert adverse effects up to delirium, ophthalmologists should inform adults, get oral informed consent and be aware of the adverse effects of the central nervous system.

Keywords

• Cyclopentolate, delirium, eye drop

Bir Yetişkinde Siklopentolat Damla Kullanımı Sonrası Gelişen Akut Deliryum

Öz

Siklopentolat damla oftalmoloji kliniklerinde refraksiyon ve fundus muayenesi öncesinde sıklıkla tercih edilen sikloplejik bir ilaçtır. %1’lik siklopentolat ile ilgili yetişkinlerde az sayıda yan etki bildirilmiştir. 82 yaşında erkek hastaya fundus muayenesi öncesinde her iki gözüne 3 kez 1’er damla %1’lik siklopentolat hidroklorür damlatıldı. Yarım saat sonra hastanın ataksik yürüyüş, bitkinlik, anlamsız konuşma gibi semptomları olduğu görüldü. Hastanın öforik bir duygu durumu ve bozulmuş bir yer-zaman algısı vardı. Yapılan nörolojik muayenesinde başka herhangi bir patolojik bulguya rastlanmadı. Semptomların ortaya çıkışından 5 saat sonra hasta tamamen normale döndü. Kontrolde hastanın retrograd amnezisi olduğu görüldü. Deliryuma kadar varan yan etkileri olabilen siklopentolatın poliklinik uygulamaları öncesinde oftalmologlar yetişkin hastaları da mutlaka bilgilendirmeli, sözlü onam almalı ve santral sinir sistemi yan etkileri açısından uyanık olmalıdırlar.

Anahtar Kelimeler

• Siklopentolat, deliryum, göz damlası

Kaynakça

1. Gordon DM, Ehrenberg MH. Cyclopentolate hydrochloride: a new mydriatic and cycloplegic agent; a pharmacologic and clinical evaluation. Am J Ophthalmol 1954;38:831-838.
2. Lovasik JV. Pharmacokinetics of topically applied cyclopentolate HCl and tropicamide. Am J Optom Physiol Opt 1986;63:787-803.
3. Awan KJ. Adverse systemic reactions of topical cyclopentolate hydrochloride. Ann Ophthalmol 1976;8:695–698.
4. Shihab ZM. Psychotic reaction in an adult after topical cyclopentolate.Ophthalmologica 1980;181:228-230.
5. 5-Mirshahi A, Kohnen T. Acute psychotic reaction caused by topical cyclopentolate use for cycloplegic refraction before refractive surgery: case report and review of the literature. J Cataract Refract Surg 2003;29:1026-1030.
6. Ostler HB. Cycloplegics and mydriatics. Tolerance, habituation, and addiction to topical administration. Arch Ophthalmol 1975;93:423-423.
7. Gleason OC. Delirium. Am Fam Physician 2003;67:1027-1034.
8. Maldonado JR. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry 2013;21:1190-1222.

9. Han L, McCusker J, Cole M, Abrahamowicz M, Primeau F, Elie M. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 2001;161:1099-1105.
10. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 5th edition. Arlington, VA: American Psychiatric Association; 2013.
11. Järvinen K, Järvinen T, Urtti A. Ocular absorption following topical delivery. Advanced drug delivery reviews 1995;16:3-19.
12. Fitzgerald DA, Hanson RM, West C, Martin F, Brown C, Kilham HA. Seizures associated with 1% cyclopentolate eyedrops. J Pediatr Child Health 1990;26:106-107.
13. Darcin AE, Dilbaz N, Yilmaz S, Cetin MK. Cyclopentolate hydrochloride eye drops addiction: a case report. J Addict Med 2011;5:84-85.
14. Bagheri A, Givrad S, Yazdani S, Reza Mohebbi M. Optimal dosage of cyclopentolate 1% for complete cycloplegia: a randomized clinical trial.Eur J Ophthalmol 2007;17:294-300.