Neuro-Ophthalmic
Pharmacologic Mydriasis
Also known as: pharmacologic mydriasis, dilating drops anisocoria, scopolamine pupil, anticholinergic pupil, dilated pupil from drops
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A large, poorly reactive pupil caused by exposure to a dilating or anticholinergic agent, whether an eye drop, a scopolamine patch, or a nebulised medicine transferred by hand. The pupil is typically widely dilated and fixed, without ptosis, double vision or any limitation of eye movement. The history settles it, and the absence of lid and motility signs is what separates it from a third nerve palsy.
Recognition
Symptoms: what patients report
- Recent dilating drop exposure.
- Patch or scopolamine exposure.
- Medication or anticholinergic exposure history.
Signs: what the examination shows
- Large fixed pupil without ptosis.
- No diplopia or EOM deficit.
- No ophthalmoplegia.
- Poor or absent pilocarpine constriction may support pharmacologic dilation where tested.
What OptoGuide™ covers for pharmacologic mydriasis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Pharmacologic Dilation of Pupil — EyeWiki
- The Neuro-Ophthalmology Survival Guide (Pane, Miller & Burdon) — standard reference text
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.