Child falls unconscious after pupil dilation in routine eye exam?

Question

Can anyone help me please. My nephew recently fell unconscious after an optometrist inserted drops in his eyes to dilate his pupils so she could perform a routine eye exam.

He is 4 years old.

He remained unconscious for 15 minutes with compromised breathing and a rapid and eratic heart rate.

On coming to his eyes remained cialted for 2 more days and looked black.

An Ambulance was called, and he is OK now... just trying to find out why this might have happened? Maybe an allergy or underlying condition that meant he should not have had this treatment?

Additional info- he was born with voacl cord palsy... origin unknown and continues to experience stridor when exercising.

Many thanks

Answer 1

alot of times people can get themselves worked up about something, sometimes hyperventilating if their nerves get the best of them. there is, also, a drop that can leave their eyes dilated for more than 24 hours.

Answer 2

That's very, very rare.

Unless the strongest of drops (atropine) was used*, which seems unlikely, as that would normally take longer for the dilation to subside, it almost has to be an idiosyncratic allergic reaction or an overdosage.  

With Cyclopentolate both have been recorded, (URL) if that was the drug, and  it's commonly used since it's one of the safest available.

While knowing it was a possibility, I never saw a case in 28 years with even minor systemic symptoms.

(but in the case below, they used five times the dosage I was taught to, even for a cycloplegic examination.  For dilation  only I'd use a shorter acting drug: tropicamide.  *But*  dilation and cycloplegia of very darkly pigmented eyes can be more difficult, and that might have lain behind the higher dosage in that instance.)

Without more details of the drug, the strength and number of drops, its difficult to comment further.

*and that's not necessarily wrong, they can be required and indeed can be used on a repeated basis in some children as treatment for amblyopia.

Answer 3

It sounds like your nephew had either an allergic reaction or the drops cause vasoconstriction which led to him passing out.  What kind of drops were used?  I would advise the mother to tell any future eye doctor of this reaction and not have the same drops used again. It is a very rare reaction.  We always ask our patients if they have any heart or vascular conditions before they have the drops administered.  Perhaps a trip to the GP to rule out and vascular problems or even heart problems, not to scare you, but it IS a rare reaction.  Best of luck :)