Pharmacologic Mydriasis Secondary to Topical Glycopyrronium Tosylate Cloths: Clinical Characterization From a Multicenter Analysis

Authors

Aaron R. Kaufman, Department of Ophthalmology and Visual Sciences (ARK, SG, PWM, BTJ, KMC), Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois; NorthShore University Health System (JHP), Evanston, Illinois; Department of Ophthalmology (TMJ, NRC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Neurology (NRC), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Des Peres Eye Center (EC), Des Peres, Missouri; Department of Ophthalmology (EAS), Rush University Medical Center, Chicago, Illinois; Department of Ophthalmology (KCG), University of Cincinnati College of Medicine (KCG), Cincinnati, Ohio; Cincinnati Eye Institute (KCG), Cincinnati, Ohio; and Midwest Retina Consultants (EG-V), Arlington Heights, Illinois.
Shawn Gulati
John H. Pula
Timothy M. Janetos
Neena R. Cherayil
Eric Chiu
Emily Anne Shepherd
Karl C. Golnik
Enrique Garcia-Valenzuela
Peter W. MacIntosh
Brooke T. Johnson
Kimberlee M. Curnyn

Document Type

Article

Abstract

BACKGROUND: Topical glycopyrronium tosylate (GT) is an anticholinergic medication for treatment of axillary hyperhidrosis. Pharmacologic mydriasis and anisocoria from topical GT has been reported and may be underrecognized. This study aims to clinically characterize patients presenting with pharmacologic mydriasis from exposure to this medication. METHODS: This study is a retrospective observational case series. A multicenter chart review of 16 patients diagnosed with pharmacologic mydriasis secondary to topical GT was performed. RESULTS: Eight patients (50.0%) were age 18 years and younger, and 14 patients (87.5%) were female. Unilateral mydriasis (anisocoria) occurred in 14 patients (87.5%). Fourteen patients (87.5%) did not initially volunteer topical GT as a "medication," and the history of topical GT exposure needed to be elicited with further questioning. Hand hygiene details were known for 12 patients, and all reported that they did not wash their hands after GT application. Six patients (37.5%) were soft contact lens users. One patient had possible exposure through a family member's use of the medication. Ocular symptoms were common (blurry vision [11 patients, 68.8%] and eye dryness [7 patients, 43.8%]), but systemic anticholinergic symptoms were uncommon (such as constipation [1 patient, 6.3%] and urinary symptoms [3 patients, 18.8%]). CONCLUSIONS: Mydriasis associated with topical GT seems to be a consequence of local exposure rather than systemic toxicity. Because patients may not volunteer topical GT as a medication, eliciting a history of exposure often requires further specific questioning. Soft contact lens wear and poor postapplication hand hygiene seem to be associated with mydriasis in GT use.

Medical Subject Headings

Humans; Female; Adolescent; Male; Mydriasis (chemically induced, diagnosis, drug therapy); Anisocoria (drug therapy); Retrospective Studies; Cholinergic Antagonists (adverse effects)

Publication Date

12-1-2022

Publication Title

Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society

E-ISSN

1536-5166

Volume

42

Issue

4

First Page

530

Last Page

534

PubMed ID

35427257

Digital Object Identifier (DOI)

10.1097/WNO.0000000000001567

Recommended Citation

Kaufman, Aaron R.; Gulati, Shawn; Pula, John H.; Janetos, Timothy M.; Cherayil, Neena R.; Chiu, Eric; Shepherd, Emily Anne; Golnik, Karl C.; Garcia-Valenzuela, Enrique; MacIntosh, Peter W.; Johnson, Brooke T.; and Curnyn, Kimberlee M., "Pharmacologic Mydriasis Secondary to Topical Glycopyrronium Tosylate Cloths: Clinical Characterization From a Multicenter Analysis" (2022). Neurology. 1613.
https://scholar.barrowneuro.org/neurology/1613