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• W1994336713 abstract "To the Editor:—Topically applied ophthalmic medications are often used by elderly patients. These drugs are intended to only produce local effects, but often a significant amount of drug may become systemically absorbed.1 We report a case of a homatropine-induced confusional state in an elderly patient. A 78-year-old male black with a history of an acquired factor VIII deficiency, hypertension, and cataract of the right eye was admitted to our Geriatric Evaluation Unit for evaluation of dementia (Folstein Mini-Mental Status2 of 15) and physical reconditioning. Subsequently, the patient underwent extracapsular lens extraction with intraoccular lens implant in his right eye. He tolerated the procedure well and was returned to our care four days postoperatively. Homatropine 5% and neomycin/dexamethasone eye drops were placed at the patient's bedside for his personal use. The patient remained at his previous cognitive level. On the fifth postoperative evening, the patient became agitated and acutely confused. Upon examination, we found that the patient had instilled the homatropine ophthalmic solution frequently into his right eye as he believed a larger dose would improve the pain he was experiencing. The only pertinent physical finding was that the patient's right eye was markedly dilated. The bedside medications were removed from the patient's room and the homatropine discontinued. The patient rapidly recovered to his baseline cognitive state and did not experience any further episodes of agitation or acute confusion during his hospitalization. Delerium following cataract surgery is well recognized.3 Although there are several case reports of homatropine and other anticholinergic mydratic drugs causing mental status changes in infants and children,4 to our knowledge there are no reports of mental status changes associated with homatropine use in adults. After reviewing the medical literature prior to 1977, Summers and Reich3 summized that the delerium often following cataract surgery was probably due to anticholinergic intoxication with an incidence between 0.3% and 15.9%. Interestingly, the data generated by Summers and Reich's own study did not support the association of age or previous psychiatric illness, risk factors often suggested by other reports. For example, cyclopentolate was associated with mental status changes in an elderly male characterized by decompensation of a previously compensated chronic dementia,5 and the administration of scopalamine eye drops to a 60-year-old African male resulted in drowsiness soon leading to unconsciousness.6 Our case highlights the fact that patients should throughly understand the indications and possible side effects of their medications before they are allowed to administer them without supervision. We do not know if our patient's possible dementia prior to receiving homatropine contributed to the acute confusional state after surgery or if our patient would have developed CNS side effects after the surgery anyway. Nevertheless, our case suggests that topically applied homatropine may cause reversible mental status changes in certain susceptible elderly patients and that this medication should be used with caution and under supervision in cognitively impaired individuals." @default.
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• W1994336713 date "1988-07-01" @default.
• W1994336713 modified "2023-10-18" @default.
• W1994336713 title "Homatropine-associated Confusion in an Elderly Patient" @default.
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• W1994336713 doi "https://doi.org/10.1111/j.1532-5415.1988.tb06164.x" @default.
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