Anisocoria due to the Datura Plant

Unilateral unresponsive dilatation of the pupil is an alarming finding and may be secondary to a wide range of ocular and neurological disorders. Ocular side effects, particularly pupillary dilation with blurring of vision may be alarming because they can indicate potentially lethal conditions related to some kinds of plants with local and systemic effects. It may also be only a topical side effect without any systemic disorder. We herein report a case of mydriasis related to the datura plant. The right pupil of the patient was dilated and unresponsive to both the pupillary light reflex (direct, consensual) and the accommodation reflex. There was no accompanying headache, diplopia, or other neurological symptom. Topical pilocarpine 2% induced normal constriction of the left pupil but had no effect on the right, confirming the pharmacological basis of the right mydriasis. Pupil size and accommodation gradually returned to normal after three days without any treatment. In some conditions as in this case the pupil dilation with blurring of vision is only a topical side effect of some kinds of plants without any systemic disorder. A detailed history and this simple topical pilocarpin test provided us vaulable information and eliminated the need for unnecessary expensive neuro-imaging and the use of unnecessary medication.It also prevented us from squandering the time of the emergency services.. (Marmara Medical Journal 2012;25:93-5)