Unilateral mydriasis due to Angel's trumpet

INTRODUCTION: There are many causes of bilateral and unilateral mydriasis. Common garden plants, such as Brugmansia (Angel's trumpet), contain tropane alkaloids. CASE REPORT: An 11-year-old girl was brought to the Emergency Department because of discomfort and difficulty with near vision in the left eye, accompanied by unilateral mydriasis (pupil approximately 8 mm, unresponsive to both papillary light reflex and accommodation reflex). The consensual papillary light reflex of the right eye, the anterior chambers, the fundi, and the extraocular movements were intact. The history revealed that she had been playing in the garden and had just touched "a nice pink flower, similar to a trumpet." Treatment was symptomatic and supportive, and the anisocoria resolved 48 hours after exposure. Morphological and chemical investigations showed high amounts of parasympatholytic tropane alkaloids in a corolla area rich in Dargendorff-positive glandular hairs. DISCUSSION: Simple topical exposure to the flowers of Angel's trumpet, without instillation of plant sap into the eye, can produce self-limited unilateral mydriasis. CONCLUSIONS: This case adds to the differential diagnosis of acute anisocoria in otherwise healthy children. An accurate and detailed history will avoid unnecessary and expensive diagnostic tests. It is important for parents and garden suppliers have information about the potential adverse effects after handling Angel's trumpet plants