Pharmacologic anisocoria secondary to topical glycopyrronium for axillary hyperhidrosis: an emerging clinical presentation

Kaufman, Aaron R.; Gulati, Shawn; Curnyn, Kimberlee M

doi:10.1016/j.jcjo.2020.06.009

Cited by 2 publications

(4 citation statements)

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“…Accurate diagnosis by clinical history may assuage patient anxiety and avoid nondiagnostic imaging, which is both expensive and unnecessary (9,10,13,14). In the absence of clinical suspicion for an alternate etiology for mydriasis, radiologic imaging does not play a role in the evaluation of the patient with mydriasis suspected to be pharmacologic in nature.…”

Section: Discussionmentioning

confidence: 99%

“…Other series have also reported multiple pediatric patients (14). Accurate diagnosis of mydriasis and anisocoria as occurring secondary to topical GT is particularly important in pediatric patients, in whom radiographic imaging stewardship to reduce radiation exposure is essential (9).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, since this medication's FDA approval in 2018, there have been increasing clinical reports of patients presenting with pharmacologic mydriasis and anisocoria secondary to topical GT. This unusual cause of pharmacologic mydriasis and anisocoria may be underrecognized owing to its recent FDA approval; however, cases may be occurring with increasing frequency as dermatologic prescribing patterns progress (9). Any patient with new anisocoria requires careful diagnostic evaluation because processes such as Horner syndrome and third nerve palsy may occur secondary to life-threatening processes; by contrast, pharmacologic mydriasis/anisocoria from topical GT is a benign process.…”

mentioning

confidence: 99%

“…This study herein describes the largest reported analysis of patients with pharmacologic mydriasis secondary to inadvertent ocular exposure to topical GT to better characterize clinical characteristics of these patients and identify possible risk factors for exposure. Three patients in this series have been previously preliminarily reported in a cautionary letter to the editor in which only limited clinical details about the patients were provided (9). Additional data from these 3 patients and all data regarding the other patients in this series are newly reported in a multicenter analysis.…”

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confidence: 99%

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

Kaufman¹,

Gulati²,

Pula³

et al. 2022

Journal of Neuro-Ophthalmology

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Kaufman¹,

Gulati²,

Pula³

et al. 2022

Journal of Neuro-Ophthalmology

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Urinary retention and mydriasis secondary to topical glycopyrronium for axillary hyperhidrosis

Green

Ray

Buchanan

et al. 2023

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Glycopyrronium, also known as glycopyrrolate, is an antimuscarinic competitive inhibitor of acetylcholine widely utilized topically for its anticholinergic properties in dermatology. A single topical glycopyrronium tosylate (GT) formulation is available on the market, and prescription of this medication has become increasingly popular among dermatologists. This medication has a relatively notable adverse effect profile and carries risks that patients need to be counseled on before initiation. Summary A 22-year-old female presented to our emergency department (ED) with a chief complaint of difficulty urinating for 48 hours and blurred vision for 2 weeks. Over the course of a week, she visited the ED once and urgent care multiple times due to complications associated with combination use of GT and cetirizine. Although these clinical effects were reversible, the patient impact in our case was profound given the time, cost, and invasive nature of these visits. Conclusion The notable adverse effects of GT should be considered when prescribing this agent.

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Pharmacologic anisocoria secondary to topical glycopyrronium for axillary hyperhidrosis: an emerging clinical presentation

Cited by 2 publications

References 3 publications

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

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

Urinary retention and mydriasis secondary to topical glycopyrronium for axillary hyperhidrosis

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