Midriasis

A healthy 3-year old boy was brought to the emergency department because of an acutely dilated right pupil, which developed after he had played in the garden. Half an hour before presentation, his parents noticed he had been crying. They reported no fall and no ocular or head trauma. The right eye showed no pupillary light reflex and no accommodation. Physical examination was otherwise normal. A detailed history revealed that he had touched and held a flower from an angel’s trumpet plant  and then rubbed his right eye. Angel’s trumpet, a member of the genus brugmansia, is an ornamental plant from South America that is increasingly found worldwide and contains parasympatholytic alkaloids such as scopolamine, hyoscyamine, and atropine. (adapted from NEJM)

Image from NEJM (link)

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