Infant pupil dilation

Because tropicamide is reported to be devoid of vasopressor effects in adults, it is one of the safest mydriatic agents for use in patients with systemic hypertension, angina, or other cardiovascular disease. Tropicamide has also been shown to be the safest agent (as indexed by changes in blood pressure and heart rate) for dilated retinal examinations in neonates. Additional information on pupil dilation in infants may be foimd in Chapter 8. 

In young children, accidental ingestion leads to the rapid onset of drowsiness, hypotonia, dilated pupils, and coma. Fortunately, gradual recovery occurs spontaneously, barring accidents. Passive inhalation of marijuana in infants can have serious consequences. 

A 15-month-old infant developed seizures (132). Her heart rate was 200/minute, here peripheries were cya-nosed, and she had labored breathing, dilated pupils reacting sluggishly to light, and a temperature of 37.3° C. There was a rash over the right iliac fossa. Her neck and back were arched. Her liver was enlarged. There was no response to rectal diazepam, rectal paraldehyde, or intravenous lorazepam, but she responded to phenytoin and anesthesia with thiopental and suxamethonium. Amphetamine was detected in her urine. 

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