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• W2048510786 abstract "To the Editor: A 24-year-old woman presented to the emergency department complaining of unequal pupils. An hour before presenting, she experienced left eye discomfort and noted bright halos around lights. She had no other complaints and denied any history of head trauma or exposure to drugs or chemicals. Her only medication was oral contraceptives. On examination, vital signs and mental status were normal, and abdominal, cardiovascular, and respiratory examinations were unremarkable. Neurologic examination showed a right pupil that was round and reactive to light, constricting from 4 mm to 2 mm. The left pupil was dilated to approximately 9 mm, fixed, and nonreactive to light (Figure). The fundi were normal. Extraocular movements were intact, and the rest of her neurologic examination was nonfocal. Review of systems revealed dyspnea a day earlier after cutting open the spiky pods of a moonflower plant to collect the seeds and shaking them into a bag, and repeat contact with the plant on the day of presentation. A presumptive diagnosis of moonflower-induced unilateral mydriasis presenting as anisocoria was made. The patient was discharged home with instructions to protect her eyes from bright light and to refrain from activities such as driving. On follow-up, the patient's anisocoria and symptoms fully resolved after 36 hours without any sequelae. We present a case of anisocoria caused by casual handling of moonflower seeds and local contamination of the eye. Anticholinergics in the seeds cause mydriasis by blocking the postganglionic parasympathetic nerve endings in the pupilloconstrictor or sphincter muscle of the iris. There has been a case report of anisocoria caused by another plant, jimsonweed, although a MEDLINE search showed no prior case reports of anisocoria caused by moonflowers in human beings.1.Savitt D.L. Roberts J.R. Seigel E.G. Anisocoria from jimsonweed.JAMA. 1986; 255: 1439-1440Crossref PubMed Scopus (11) Google Scholar Recognizable by their white bell-shaped flowers approximately 6 inches in length that bloom at dusk, moonflower plants contain scopolamine and hyoscyamine. These organic chemicals have anticholinergic properties similar to atropine. The Centers for Disease Control and Prevention (CDC) recently released information about moonflower intoxication after multiple patients in the Midwest developed anticholinergic symptoms, including dilated pupils, tachycardia, hallucinations, and urinary retention, within 60 minutes after ingesting products from the species of moonflower Datura inoxia.2.Centers for Disease Control and Prevention Suspected moonflower intoxication–Ohio, 2002.MMWR Morb Mortal Wkly Rep. 2003; 52: 788-791PubMed Google Scholar In all 14 patients, bilateral symmetric mydriasis was a consistent finding, which is expected with systemic scopolamine exposure resulting from ingestion. On further questioning, our patient's description of the moonflower plant matches that of species D inoxia. Moonflower plants are available through garden suppliers, especially in the Midwest where it is used as a sweetly fragranced ornamental plant. The basis for the CDC report was to alert physicians of moonflower intoxication through seed and plant product ingestion, in light of the availability of moonflowers and possible recreational abuse for its hallucinogenic properties. This case represents another interesting addition to the differential diagnosis of anisocoria. Adolescents, parents, and garden suppliers should be educated of this potential adverse effect when handling moonflower plants. Careful history taking, including exposure to moonflowers, may avoid an expensive workup." @default.
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• W2048510786 date "2004-12-01" @default.
• W2048510786 modified "2023-09-23" @default.
• W2048510786 title "Moonflower-induced anisocoria" @default.
• W2048510786 cites W2010346390 @default.
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• W2048510786 doi "https://doi.org/10.1016/j.annemergmed.2004.05.030" @default.
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